{"hospital_name":"Fulton County Health Center","last_updated_on":"2026-04-01","version":"3.0.0","location_name":["Fulton County Health Center"],"hospital_address":["725 South Shoop Avenue, Wauseon, OH 43567"],"license_information":{"license_number":"1177","state":"OH"},"type_2_npi":["1548279714","1952633026"],"attestation":{"attestation":"To the best of its knowledge and belief, this hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date in the file. This hospital has included all payer-specific negotiated charges in dollars that can be expressed as a dollar amount. For payer-specific negotiated charges that cannot be expressed as a dollar amount in the machine-readable file or not knowable in advance, the hospital attests that the payer-specific negotiated charge is based on a contractual algorithm, percentage or formula that precludes the provision of a dollar amount and has provided all necessary information available to the hospital for the public to be able to derive the dollar amount, including, but not limited to, the specific fee schedule or components referenced in such percentage, algorithm or formula.","confirm_attestation":true,"attester_name":"Patricia Finn"},"modifier_information":[{"description":"Distinct Procedural Service","code":"59","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Better Health MyCare Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"AmeriHealth","plan_name":"Caritas Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"BlueCard Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"CareSource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthsmart Network","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"McLaren","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"McLaren","plan_name":"MI  Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medben Northern Buckeye group","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual of Ohio","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual of Ohio","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual of Ohio","plan_name":"Mercy Network Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"MyCare Medicare/Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Paramount","plan_name":"Marketplace Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Right side (used to identify procedures performed on the right side of the body)","code":"RT","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Better Health MyCare Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"AmeriHealth","plan_name":"Caritas Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"BlueCard Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"CareSource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthsmart Network","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"McLaren","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"McLaren","plan_name":"MI  Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medben Northern Buckeye group","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual of Ohio","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual of Ohio","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual of Ohio","plan_name":"Mercy Network Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"MyCare Medicare/Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Paramount","plan_name":"Marketplace Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Left side (used to identify procedures performed on the left side of the body)","code":"LT","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Better Health MyCare Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"AmeriHealth","plan_name":"Caritas Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"BlueCard Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"CareSource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthsmart Network","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"McLaren","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"McLaren","plan_name":"MI  Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medben Northern Buckeye group","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual of Ohio","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual of Ohio","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual of Ohio","plan_name":"Mercy Network Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"MyCare Medicare/Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Paramount","plan_name":"Marketplace Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Bilateral Procedure","code":"50","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Better Health MyCare Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"AmeriHealth","plan_name":"Caritas Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"BlueCard Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"CareSource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthsmart Network","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"McLaren","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"McLaren","plan_name":"MI  Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medben Northern Buckeye group","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual of Ohio","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual of Ohio","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual of Ohio","plan_name":"Mercy Network Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"MyCare Medicare/Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Paramount","plan_name":"Marketplace Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities","code":"TC","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Better Health MyCare Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"AmeriHealth","plan_name":"Caritas Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"BlueCard Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"CareSource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthsmart Network","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"McLaren","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"McLaren","plan_name":"MI  Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medben Northern Buckeye group","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual of Ohio","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual of Ohio","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual of Ohio","plan_name":"Mercy Network Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"MyCare Medicare/Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Paramount","plan_name":"Marketplace Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Investigational clinical service provided in a clinical research study that is in an approved clinical research study","code":"Q0","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Better Health MyCare Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"AmeriHealth","plan_name":"Caritas Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"BlueCard Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"CareSource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthsmart Network","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"McLaren","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"McLaren","plan_name":"MI  Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medben Northern Buckeye group","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual of Ohio","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual of Ohio","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual of Ohio","plan_name":"Mercy Network Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"MyCare Medicare/Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Paramount","plan_name":"Marketplace Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Separate practitioner, a service that is distinct because it was performed by a different practitioner","code":"XP","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Better Health MyCare Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"AmeriHealth","plan_name":"Caritas Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"BlueCard Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"CareSource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthsmart Network","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"McLaren","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"McLaren","plan_name":"MI  Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medben Northern Buckeye group","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual of Ohio","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual of Ohio","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual of Ohio","plan_name":"Mercy Network Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"MyCare Medicare/Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Paramount","plan_name":"Marketplace Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Reduced Services","code":"52","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Better Health MyCare Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"AmeriHealth","plan_name":"Caritas Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"BlueCard Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"CareSource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthsmart Network","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"McLaren","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"McLaren","plan_name":"MI  Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medben Northern Buckeye group","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual of Ohio","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual of Ohio","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual of Ohio","plan_name":"Mercy Network Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"MyCare Medicare/Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Paramount","plan_name":"Marketplace Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Reference (Outside) Laboratory","code":"90","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Better Health MyCare Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"AmeriHealth","plan_name":"Caritas Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"BlueCard Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"CareSource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthsmart Network","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"McLaren","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"McLaren","plan_name":"MI  Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medben Northern Buckeye group","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual of Ohio","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual of Ohio","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual of Ohio","plan_name":"Mercy Network Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"MyCare Medicare/Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Paramount","plan_name":"Marketplace Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Services delivered under an outpatient physical therapy plan of care","code":"GP","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Better Health MyCare Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"AmeriHealth","plan_name":"Caritas Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"BlueCard Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"CareSource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthsmart Network","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"McLaren","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"McLaren","plan_name":"MI  Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medben Northern Buckeye group","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual of Ohio","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual of Ohio","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual of Ohio","plan_name":"Mercy Network Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"MyCare Medicare/Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Paramount","plan_name":"Marketplace Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Habilitative Services","code":"96","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Better Health MyCare Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"AmeriHealth","plan_name":"Caritas Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"BlueCard Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"CareSource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthsmart Network","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"McLaren","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"McLaren","plan_name":"MI  Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medben Northern Buckeye group","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual of Ohio","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual of Ohio","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual of Ohio","plan_name":"Mercy Network Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"MyCare Medicare/Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Paramount","plan_name":"Marketplace Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Services delivered under an outpatient occupational therapy plan of care","code":"GO","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Better Health MyCare Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"AmeriHealth","plan_name":"Caritas Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"BlueCard Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"CareSource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthsmart Network","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"McLaren","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"McLaren","plan_name":"MI  Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medben Northern Buckeye group","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual of Ohio","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual of Ohio","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual of Ohio","plan_name":"Mercy Network Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"MyCare Medicare/Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Paramount","plan_name":"Marketplace Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Services delivered under an outpatient speech language pathology plan of care","code":"GN","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Better Health MyCare Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"AmeriHealth","plan_name":"Caritas Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"BlueCard Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"CareSource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthsmart Network","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"McLaren","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"McLaren","plan_name":"MI  Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medben Northern Buckeye group","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual of Ohio","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual of Ohio","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual of Ohio","plan_name":"Mercy Network Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"MyCare Medicare/Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Paramount","plan_name":"Marketplace Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Administered subcutaneously","code":"JB","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Better Health MyCare Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"AmeriHealth","plan_name":"Caritas Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"BlueCard Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"CareSource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthsmart Network","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"McLaren","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"McLaren","plan_name":"MI  Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medben Northern Buckeye group","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual of Ohio","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual of Ohio","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual of Ohio","plan_name":"Mercy Network Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"MyCare Medicare/Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Paramount","plan_name":"Marketplace Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Administered intravenously","code":"JA","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Better Health MyCare Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"AmeriHealth","plan_name":"Caritas Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"BlueCard Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"CareSource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthsmart Network","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"McLaren","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"McLaren","plan_name":"MI  Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medben Northern Buckeye group","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual of Ohio","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual of Ohio","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual of Ohio","plan_name":"Mercy Network Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"MyCare Medicare/Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Paramount","plan_name":"Marketplace Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"PHCS","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Requirements specified in the medical policy have been met","code":"KX","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Better Health MyCare Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"AmeriHealth","plan_name":"Caritas Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"BlueCard Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"CareSource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthsmart Network","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"McLaren","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"McLaren","plan_name":"MI  Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medben Northern Buckeye group","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual of Ohio","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual of Ohio","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual of Ohio","plan_name":"Mercy Network Other Commercial Plan","description":"The modified price is presented in the standard charge 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It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XR MANDIBLE MIN 4 VIEWS","code_information":[{"code":"4100021060","type":"CDM"},{"code":"320","type":"RC"},{"code":"70110","type":"HCPCS"}],"standard_charges":[{"gross_charge":323.0,"discounted_cash":226.1,"setting":"both","modifiers":"TC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XR MASTOIDS MIN 3 VW EA SIDE","code_information":[{"code":"4100021070","type":"CDM"},{"code":"320","type":"RC"},{"code":"70130","type":"HCPCS"}],"standard_charges":[{"gross_charge":352.24,"discounted_cash":246.57,"setting":"both","modifiers":"TC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XR WATER VW FACIAL BONES <3 VW","code_information":[{"code":"4100021120","type":"CDM"},{"code":"320","type":"RC"},{"code":"70140","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":83.3,"setting":"both","modifiers":"TC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XR SKULL AP/LAT < 4 VIEWS","code_information":[{"code":"4100021130","type":"CDM"},{"code":"320","type":"RC"},{"code":"70250","type":"HCPCS"}],"standard_charges":[{"gross_charge":154.0,"discounted_cash":107.8,"setting":"both","modifiers":"TC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XR SINUSES < 3 VIEWS","code_information":[{"code":"4100021150","type":"CDM"},{"code":"320","type":"RC"},{"code":"70210","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.77,"discounted_cash":90.84,"setting":"both","modifiers":"TC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Fluoro Guide-place Port/Cath","code_information":[{"code":"4100021175","type":"CDM"},{"code":"320","type":"RC"},{"code":"77001","type":"HCPCS"}],"standard_charges":[{"gross_charge":1291.19,"discounted_cash":903.83,"setting":"both","modifiers":"TC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"FLUOROSCOPIC GUID SPINE C-ARM","code_information":[{"code":"4100021185","type":"CDM"},{"code":"320","type":"RC"},{"code":"77003","type":"HCPCS"}],"standard_charges":[{"gross_charge":287.35,"discounted_cash":201.14,"setting":"both","modifiers":"TC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Fluoroscopy Limited < 1 hr","code_information":[{"code":"4100021190","type":"CDM"},{"code":"320","type":"RC"},{"code":"76000","type":"HCPCS"}],"standard_charges":[{"gross_charge":288.99,"discounted_cash":202.29,"setting":"both","modifiers":"TC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Fluoro guidance needle plsmnt","code_information":[{"code":"410002119A","type":"CDM"},{"code":"320","type":"RC"},{"code":"77002","type":"HCPCS"}],"standard_charges":[{"gross_charge":551.8,"discounted_cash":386.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"XR SHOULDER 1 VW RT","code_information":[{"code":"4100031000","type":"CDM"},{"code":"320","type":"RC"},{"code":"73020","type":"HCPCS"}],"standard_charges":[{"gross_charge":253.5,"discounted_cash":177.45,"setting":"both","modifiers":"RTTC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body) | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XR SHOULDER 1 VIEW BIL","code_information":[{"code":"4100031005","type":"CDM"},{"code":"320","type":"RC"},{"code":"73020","type":"HCPCS"}],"standard_charges":[{"gross_charge":528.5,"discounted_cash":369.95,"setting":"both","modifiers":"TC50","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities | Modifier 50: Bilateral Procedure"}]},{"description":"XR CLAVICLE COMPLETE RT","code_information":[{"code":"4100031020","type":"CDM"},{"code":"320","type":"RC"},{"code":"73000","type":"HCPCS"}],"standard_charges":[{"gross_charge":265.0,"discounted_cash":185.5,"setting":"both","modifiers":"RTTC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body) | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XR SHOULDER COMPLETE 2+ RT","code_information":[{"code":"4100031030","type":"CDM"},{"code":"320","type":"RC"},{"code":"73030","type":"HCPCS"}],"standard_charges":[{"gross_charge":357.5,"discounted_cash":250.25,"setting":"both","modifiers":"RTTC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body) | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XR AC JOINTS BIL W-W/O WGHTS","code_information":[{"code":"4100031040","type":"CDM"},{"code":"320","type":"RC"},{"code":"73050","type":"HCPCS"}],"standard_charges":[{"gross_charge":368.0,"discounted_cash":257.6,"setting":"both","modifiers":"TC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XR HUMERUS 2+ VWS RT","code_information":[{"code":"4100031050","type":"CDM"},{"code":"320","type":"RC"},{"code":"73060","type":"HCPCS"}],"standard_charges":[{"gross_charge":323.0,"discounted_cash":226.1,"setting":"both","modifiers":"RTTC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body) | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XR FOREARM 2 VIEWS RT","code_information":[{"code":"4100031060","type":"CDM"},{"code":"320","type":"RC"},{"code":"73090","type":"HCPCS"}],"standard_charges":[{"gross_charge":308.0,"discounted_cash":215.6,"setting":"both","modifiers":"RTTC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body) | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XR ELBOW 3+ VWS RT","code_information":[{"code":"4100031070","type":"CDM"},{"code":"320","type":"RC"},{"code":"73080","type":"HCPCS"}],"standard_charges":[{"gross_charge":313.0,"discounted_cash":219.1,"setting":"both","modifiers":"RTTC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body) | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XR HAND 3+VWS RT","code_information":[{"code":"4100031080","type":"CDM"},{"code":"320","type":"RC"},{"code":"73130","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.0,"discounted_cash":179.2,"setting":"both","modifiers":"RTTC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body) | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XR WRIST 3+ VWS RT","code_information":[{"code":"4100031090","type":"CDM"},{"code":"320","type":"RC"},{"code":"73110","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.0,"discounted_cash":179.2,"setting":"both","modifiers":"RTTC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body) | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XR BONE AGE HANDS","code_information":[{"code":"4100031110","type":"CDM"},{"code":"320","type":"RC"},{"code":"77072","type":"HCPCS"}],"standard_charges":[{"gross_charge":312.43,"discounted_cash":218.70,"setting":"both","modifiers":"TC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XR ELBOW 2 VIEWS RT","code_information":[{"code":"4100031120","type":"CDM"},{"code":"320","type":"RC"},{"code":"73070","type":"HCPCS"}],"standard_charges":[{"gross_charge":235.0,"discounted_cash":164.5,"setting":"both","modifiers":"RTTC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body) | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XR HAND 2 VIEWS RT","code_information":[{"code":"4100031130","type":"CDM"},{"code":"320","type":"RC"},{"code":"73120","type":"HCPCS"}],"standard_charges":[{"gross_charge":243.5,"discounted_cash":170.45,"setting":"both","modifiers":"RTTC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body) | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XR WRIST 2 VIEWS RT","code_information":[{"code":"4100031140","type":"CDM"},{"code":"320","type":"RC"},{"code":"73100","type":"HCPCS"}],"standard_charges":[{"gross_charge":235.0,"discounted_cash":164.5,"setting":"both","modifiers":"RTTC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body) | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XR INFANT UE 2+VW RT","code_information":[{"code":"4100031150","type":"CDM"},{"code":"320","type":"RC"},{"code":"73092","type":"HCPCS"}],"standard_charges":[{"gross_charge":368.0,"discounted_cash":257.6,"setting":"both","modifiers":"RTTC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body) | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XR UE INFANT MIN 2 VW BIL","code_information":[{"code":"4100031155","type":"CDM"},{"code":"320","type":"RC"},{"code":"73092","type":"HCPCS"}],"standard_charges":[{"gross_charge":368.0,"discounted_cash":257.6,"setting":"both","modifiers":"TC50","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities | Modifier 50: Bilateral Procedure"}]},{"description":"XR STERNOCLAVICULAR JT(S) 3 VW","code_information":[{"code":"4100031160","type":"CDM"},{"code":"320","type":"RC"},{"code":"71130","type":"HCPCS"}],"standard_charges":[{"gross_charge":288.99,"discounted_cash":202.29,"setting":"both","modifiers":"TC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XR SCAPULA COMPLETE RT","code_information":[{"code":"4100031170","type":"CDM"},{"code":"320","type":"RC"},{"code":"73010","type":"HCPCS"}],"standard_charges":[{"gross_charge":368.0,"discounted_cash":257.6,"setting":"both","modifiers":"RTTC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body) | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XR HAND 3+VWS LT","code_information":[{"code":"4100031240","type":"CDM"},{"code":"320","type":"RC"},{"code":"73130","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.0,"discounted_cash":179.2,"setting":"both","modifiers":"LTTC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body) | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XR HAND 2 VIEWS LT","code_information":[{"code":"4100031300","type":"CDM"},{"code":"320","type":"RC"},{"code":"73120","type":"HCPCS"}],"standard_charges":[{"gross_charge":243.5,"discounted_cash":170.45,"setting":"both","modifiers":"LTTC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body) | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XR SHOULDER 1 VW LT","code_information":[{"code":"4100031310","type":"CDM"},{"code":"320","type":"RC"},{"code":"73020","type":"HCPCS"}],"standard_charges":[{"gross_charge":253.5,"discounted_cash":177.45,"setting":"both","modifiers":"LTTC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body) | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XR CLAVICLE COMPLETE LT","code_information":[{"code":"4100031330","type":"CDM"},{"code":"320","type":"RC"},{"code":"73000","type":"HCPCS"}],"standard_charges":[{"gross_charge":265.0,"discounted_cash":185.5,"setting":"both","modifiers":"LTTC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body) | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XR SHOULDER COMPLETE 2+ LT","code_information":[{"code":"4100031340","type":"CDM"},{"code":"320","type":"RC"},{"code":"73030","type":"HCPCS"}],"standard_charges":[{"gross_charge":357.5,"discounted_cash":250.25,"setting":"both","modifiers":"LTTC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body) | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XR HUMERUS 2+ VWS LT","code_information":[{"code":"4100031350","type":"CDM"},{"code":"320","type":"RC"},{"code":"73060","type":"HCPCS"}],"standard_charges":[{"gross_charge":323.0,"discounted_cash":226.1,"setting":"both","modifiers":"LTTC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body) | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XR FOREARM 2 VIEWS LT","code_information":[{"code":"4100031360","type":"CDM"},{"code":"320","type":"RC"},{"code":"73090","type":"HCPCS"}],"standard_charges":[{"gross_charge":308.0,"discounted_cash":215.6,"setting":"both","modifiers":"LTTC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body) | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XR ELBOW 3+ VWS LT","code_information":[{"code":"4100031370","type":"CDM"},{"code":"320","type":"RC"},{"code":"73080","type":"HCPCS"}],"standard_charges":[{"gross_charge":313.0,"discounted_cash":219.1,"setting":"both","modifiers":"LTTC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body) | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XR WRIST 3+ VWS LT","code_information":[{"code":"4100031380","type":"CDM"},{"code":"320","type":"RC"},{"code":"73110","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.0,"discounted_cash":179.2,"setting":"both","modifiers":"LTTC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body) | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XR ELBOW 2 VIEWS LT","code_information":[{"code":"4100031390","type":"CDM"},{"code":"320","type":"RC"},{"code":"73070","type":"HCPCS"}],"standard_charges":[{"gross_charge":235.0,"discounted_cash":164.5,"setting":"both","modifiers":"LTTC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body) | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XR WRIST 2 VIEWS LT","code_information":[{"code":"4100031400","type":"CDM"},{"code":"320","type":"RC"},{"code":"73100","type":"HCPCS"}],"standard_charges":[{"gross_charge":235.0,"discounted_cash":164.5,"setting":"both","modifiers":"LTTC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body) | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XR INFANT UE 2+VW LT","code_information":[{"code":"4100031410","type":"CDM"},{"code":"320","type":"RC"},{"code":"73092","type":"HCPCS"}],"standard_charges":[{"gross_charge":368.0,"discounted_cash":257.6,"setting":"both","modifiers":"LTTC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body) | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XR SCAPULA COMPLETE LT","code_information":[{"code":"4100031420","type":"CDM"},{"code":"320","type":"RC"},{"code":"73010","type":"HCPCS"}],"standard_charges":[{"gross_charge":368.0,"discounted_cash":257.6,"setting":"both","modifiers":"LTTC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body) | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XR CHEST-PA LAT/OBL","code_information":[{"code":"4100041040","type":"CDM"},{"code":"324","type":"RC"},{"code":"71048","type":"HCPCS"}],"standard_charges":[{"gross_charge":287.5,"discounted_cash":201.25,"setting":"both","modifiers":"TC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XR Chest single front view","code_information":[{"code":"4100041050","type":"CDM"},{"code":"320","type":"RC"},{"code":"71045","type":"HCPCS"}],"standard_charges":[{"gross_charge":220.0,"discounted_cash":154.0,"setting":"both","modifiers":"TC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XR RIBS W/PA CXR 3+ VWS RT","code_information":[{"code":"4100041060","type":"CDM"},{"code":"320","type":"RC"},{"code":"71101","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.5,"discounted_cash":227.85,"setting":"both","modifiers":"RTTC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body) | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XR STERNUM MIN 2 VIEWS","code_information":[{"code":"4100041080","type":"CDM"},{"code":"320","type":"RC"},{"code":"71120","type":"HCPCS"}],"standard_charges":[{"gross_charge":265.0,"discounted_cash":185.5,"setting":"both","modifiers":"TC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"DEXA BONE DENSITY AXIAL","code_information":[{"code":"4100041170","type":"CDM"},{"code":"320","type":"RC"},{"code":"77080","type":"HCPCS"}],"standard_charges":[{"gross_charge":497.83,"discounted_cash":348.48,"setting":"both","modifiers":"TC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XR RIBS W/PA CXR 3+ VWS LT","code_information":[{"code":"4100041190","type":"CDM"},{"code":"320","type":"RC"},{"code":"71101","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.5,"discounted_cash":227.85,"setting":"both","modifiers":"LTTC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body) | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XR SPINE CERV  MIN 4 VIEWS","code_information":[{"code":"4100051010","type":"CDM"},{"code":"320","type":"RC"},{"code":"72050","type":"HCPCS"}],"standard_charges":[{"gross_charge":421.0,"discounted_cash":294.7,"setting":"both","modifiers":"TC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XR SPINE THORACIC 3 VIEWS","code_information":[{"code":"4100051020","type":"CDM"},{"code":"320","type":"RC"},{"code":"72072","type":"HCPCS"}],"standard_charges":[{"gross_charge":402.5,"discounted_cash":281.75,"setting":"both","modifiers":"TC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XR SACRUM/COCYX MIN 2 VW","code_information":[{"code":"4100051050","type":"CDM"},{"code":"320","type":"RC"},{"code":"72220","type":"HCPCS"}],"standard_charges":[{"gross_charge":263.5,"discounted_cash":184.45,"setting":"both","modifiers":"TC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XR SI JOINTS 3+ VIEWS","code_information":[{"code":"4100051070","type":"CDM"},{"code":"320","type":"RC"},{"code":"72202","type":"HCPCS"}],"standard_charges":[{"gross_charge":265.0,"discounted_cash":185.5,"setting":"both","modifiers":"TC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XR PELVIS 1-2 VIEWS","code_information":[{"code":"4100051080","type":"CDM"},{"code":"320","type":"RC"},{"code":"72170","type":"HCPCS"}],"standard_charges":[{"gross_charge":257.5,"discounted_cash":180.25,"setting":"both","modifiers":"TC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XR SPINE 1 VIEW","code_information":[{"code":"4100051105","type":"CDM"},{"code":"320","type":"RC"},{"code":"72020","type":"HCPCS"}],"standard_charges":[{"gross_charge":253.5,"discounted_cash":177.45,"setting":"both","modifiers":"TC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XR SPINE LUMBOSACRAL 2-3 VW","code_information":[{"code":"4100051110","type":"CDM"},{"code":"320","type":"RC"},{"code":"72100","type":"HCPCS"}],"standard_charges":[{"gross_charge":257.5,"discounted_cash":180.25,"setting":"both","modifiers":"TC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XR SPINE LUMBAR W/BND => 6VW","code_information":[{"code":"4100051130","type":"CDM"},{"code":"320","type":"RC"},{"code":"72114","type":"HCPCS"}],"standard_charges":[{"gross_charge":519.0,"discounted_cash":363.3,"setting":"both","modifiers":"TC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XR LUMBOSACRL BEND 2-3 VWS","code_information":[{"code":"4100051150","type":"CDM"},{"code":"320","type":"RC"},{"code":"72120","type":"HCPCS"}],"standard_charges":[{"gross_charge":323.0,"discounted_cash":226.1,"setting":"both","modifiers":"TC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XR SPINE CERVICAL 2 OR 3 VWS","code_information":[{"code":"4100051170","type":"CDM"},{"code":"320","type":"RC"},{"code":"72040","type":"HCPCS"}],"standard_charges":[{"gross_charge":313.0,"discounted_cash":219.1,"setting":"both","modifiers":"TC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XR SPINE CERVICAL 6 + VIEWS","code_information":[{"code":"4100051180","type":"CDM"},{"code":"320","type":"RC"},{"code":"72052","type":"HCPCS"}],"standard_charges":[{"gross_charge":494.0,"discounted_cash":345.8,"setting":"both","modifiers":"TC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XR HIP DURING OPERATION","code_information":[{"code":"4100061020","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":702.84,"discounted_cash":491.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"XR KNEE 3 VIEWS RT","code_information":[{"code":"4100061050","type":"CDM"},{"code":"320","type":"RC"},{"code":"73562","type":"HCPCS"}],"standard_charges":[{"gross_charge":289.0,"discounted_cash":202.3,"setting":"both","modifiers":"RTTC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body) | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XR LOW LEG 2 VWS RT","code_information":[{"code":"4100061060","type":"CDM"},{"code":"320","type":"RC"},{"code":"73590","type":"HCPCS"}],"standard_charges":[{"gross_charge":299.5,"discounted_cash":209.65,"setting":"both","modifiers":"RTTC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body) | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XR ANKLE CMPLT 3+ VWS RT","code_information":[{"code":"4100061070","type":"CDM"},{"code":"320","type":"RC"},{"code":"73610","type":"HCPCS"}],"standard_charges":[{"gross_charge":257.5,"discounted_cash":180.25,"setting":"both","modifiers":"RTTC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body) | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XR FOOT 3+ VWS RT","code_information":[{"code":"4100061080","type":"CDM"},{"code":"320","type":"RC"},{"code":"73630","type":"HCPCS"}],"standard_charges":[{"gross_charge":257.5,"discounted_cash":180.25,"setting":"both","modifiers":"RTTC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body) | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XR HEEL 2+ VWS RT","code_information":[{"code":"4100061100","type":"CDM"},{"code":"320","type":"RC"},{"code":"73650","type":"HCPCS"}],"standard_charges":[{"gross_charge":265.0,"discounted_cash":185.5,"setting":"both","modifiers":"RTTC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body) | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XR LEG LENGTH","code_information":[{"code":"4100061110","type":"CDM"},{"code":"320","type":"RC"},{"code":"77073","type":"HCPCS"}],"standard_charges":[{"gross_charge":403.5,"discounted_cash":282.45,"setting":"both","modifiers":"TC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XR KNEE COMPLETE 4+VWS RT","code_information":[{"code":"4100061120","type":"CDM"},{"code":"320","type":"RC"},{"code":"73564","type":"HCPCS"}],"standard_charges":[{"gross_charge":402.0,"discounted_cash":281.4,"setting":"both","modifiers":"RTTC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body) | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XR KNEE 1-2 VWS RT","code_information":[{"code":"4100061150","type":"CDM"},{"code":"320","type":"RC"},{"code":"73560","type":"HCPCS"}],"standard_charges":[{"gross_charge":323.0,"discounted_cash":226.1,"setting":"both","modifiers":"RTTC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body) | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XR ANKLE 2 VWS RT","code_information":[{"code":"4100061170","type":"CDM"},{"code":"320","type":"RC"},{"code":"73600","type":"HCPCS"}],"standard_charges":[{"gross_charge":235.0,"discounted_cash":164.5,"setting":"both","modifiers":"RTTC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body) | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XR FOOT 2 VWS RT","code_information":[{"code":"4100061180","type":"CDM"},{"code":"320","type":"RC"},{"code":"73620","type":"HCPCS"}],"standard_charges":[{"gross_charge":245.0,"discounted_cash":171.5,"setting":"both","modifiers":"RTTC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body) | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XR INFANT LE 2+ VWS RT","code_information":[{"code":"4100061190","type":"CDM"},{"code":"320","type":"RC"},{"code":"73592","type":"HCPCS"}],"standard_charges":[{"gross_charge":368.0,"discounted_cash":257.6,"setting":"both","modifiers":"RTTC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body) | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XR FOOT COMPLETE  3 VWS LT","code_information":[{"code":"4100061290","type":"CDM"},{"code":"320","type":"RC"},{"code":"73630","type":"HCPCS"}],"standard_charges":[{"gross_charge":257.5,"discounted_cash":180.25,"setting":"both","modifiers":"LTTC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body) | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XR KNEE 3 VIEWS LT","code_information":[{"code":"4100061360","type":"CDM"},{"code":"320","type":"RC"},{"code":"73562","type":"HCPCS"}],"standard_charges":[{"gross_charge":289.0,"discounted_cash":202.3,"setting":"both","modifiers":"LTTC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body) | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XR LOW LEG 2 VWS LT","code_information":[{"code":"4100061370","type":"CDM"},{"code":"320","type":"RC"},{"code":"73590","type":"HCPCS"}],"standard_charges":[{"gross_charge":299.5,"discounted_cash":209.65,"setting":"both","modifiers":"LTTC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body) | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XR ANKLE CMPLT 3+ VWS LT","code_information":[{"code":"4100061380","type":"CDM"},{"code":"320","type":"RC"},{"code":"73610","type":"HCPCS"}],"standard_charges":[{"gross_charge":257.5,"discounted_cash":180.25,"setting":"both","modifiers":"LTTC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body) | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XR HEEL 2+ VWS LT","code_information":[{"code":"4100061400","type":"CDM"},{"code":"320","type":"RC"},{"code":"73650","type":"HCPCS"}],"standard_charges":[{"gross_charge":265.0,"discounted_cash":185.5,"setting":"both","modifiers":"LTTC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body) | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XR KNEE COMPLETE 4+VWS LT","code_information":[{"code":"4100061410","type":"CDM"},{"code":"320","type":"RC"},{"code":"73564","type":"HCPCS"}],"standard_charges":[{"gross_charge":402.0,"discounted_cash":281.4,"setting":"both","modifiers":"LTTC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body) | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XR KNEE 1-2 VWS LT","code_information":[{"code":"4100061430","type":"CDM"},{"code":"320","type":"RC"},{"code":"73560","type":"HCPCS"}],"standard_charges":[{"gross_charge":323.0,"discounted_cash":226.1,"setting":"both","modifiers":"LTTC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body) | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XR ANKLE 2 VWS LT","code_information":[{"code":"4100061450","type":"CDM"},{"code":"320","type":"RC"},{"code":"73600","type":"HCPCS"}],"standard_charges":[{"gross_charge":235.0,"discounted_cash":164.5,"setting":"both","modifiers":"LTTC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body) | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XR FOOT 2 VWS LT","code_information":[{"code":"4100061460","type":"CDM"},{"code":"320","type":"RC"},{"code":"73620","type":"HCPCS"}],"standard_charges":[{"gross_charge":245.0,"discounted_cash":171.5,"setting":"both","modifiers":"LTTC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body) | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XR INFANT LOWER EXT 2+VWS LT","code_information":[{"code":"4100061470","type":"CDM"},{"code":"320","type":"RC"},{"code":"73592","type":"HCPCS"}],"standard_charges":[{"gross_charge":401.32,"discounted_cash":280.92,"setting":"both","modifiers":"TC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XR ABD SINGLE A/P VIEW","code_information":[{"code":"4100071010","type":"CDM"},{"code":"320","type":"RC"},{"code":"74018","type":"HCPCS"}],"standard_charges":[{"gross_charge":238.5,"discounted_cash":166.95,"setting":"both","modifiers":"TC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XR ESOPHAGUS CONTRAST","code_information":[{"code":"4100071050","type":"CDM"},{"code":"320","type":"RC"},{"code":"74220","type":"HCPCS"}],"standard_charges":[{"gross_charge":401.5,"discounted_cash":281.05,"setting":"both","modifiers":"TC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"Upper GI w/wo barium swallow","code_information":[{"code":"4100071060","type":"CDM"},{"code":"320","type":"RC"},{"code":"74246","type":"HCPCS"}],"standard_charges":[{"gross_charge":675.04,"discounted_cash":472.53,"setting":"both","modifiers":"TC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"UPPER GI W/O KUB","code_information":[{"code":"4100071070","type":"CDM"},{"code":"320","type":"RC"},{"code":"74240","type":"HCPCS"}],"standard_charges":[{"gross_charge":495.1,"discounted_cash":346.57,"setting":"both","modifiers":"TC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"BARIUM ENEMA - AIR CONTRAST","code_information":[{"code":"4100071080","type":"CDM"},{"code":"320","type":"RC"},{"code":"74280","type":"HCPCS"}],"standard_charges":[{"gross_charge":701.76,"discounted_cash":491.23,"setting":"both","modifiers":"TC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"COLON BARIUM ENEMA STUDY","code_information":[{"code":"4100071090","type":"CDM"},{"code":"320","type":"RC"},{"code":"74270","type":"HCPCS"}],"standard_charges":[{"gross_charge":567.07,"discounted_cash":396.95,"setting":"both","modifiers":"TC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XR SMALL BOWEL SERIES CNTRST","code_information":[{"code":"4100071100","type":"CDM"},{"code":"320","type":"RC"},{"code":"74250","type":"HCPCS"}],"standard_charges":[{"gross_charge":500.0,"discounted_cash":350.0,"setting":"both","modifiers":"TC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CHOLANGIOGRAM DURING SURG","code_information":[{"code":"4100071190","type":"CDM"},{"code":"320","type":"RC"},{"code":"74300","type":"HCPCS"}],"standard_charges":[{"gross_charge":538.73,"discounted_cash":377.11,"setting":"both","modifiers":"TC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"RAD SWALLOWING FUNCT W/VIDEO","code_information":[{"code":"4100071210","type":"CDM"},{"code":"320","type":"RC"},{"code":"74230","type":"HCPCS"}],"standard_charges":[{"gross_charge":543.63,"discounted_cash":380.54,"setting":"both","modifiers":"XPTC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier XP: Separate practitioner, a service that is distinct because it was performed by a different practitioner | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"INTRAVENOUS PYELOGRAM","code_information":[{"code":"4100081010","type":"CDM"},{"code":"320","type":"RC"},{"code":"74400","type":"HCPCS"}],"standard_charges":[{"gross_charge":480.92,"discounted_cash":336.64,"setting":"both","modifiers":"TC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"VOIDING CYSTOGRAM","code_information":[{"code":"4100081030","type":"CDM"},{"code":"320","type":"RC"},{"code":"74455","type":"HCPCS"}],"standard_charges":[{"gross_charge":428.58,"discounted_cash":300.01,"setting":"both","modifiers":"TC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"RETROGRADE PYELOGRAM UNI","code_information":[{"code":"4100081040","type":"CDM"},{"code":"320","type":"RC"},{"code":"74420","type":"HCPCS"}],"standard_charges":[{"gross_charge":534.36,"discounted_cash":374.05,"setting":"both","modifiers":"TC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"UTEROSALPINGOGRAM","code_information":[{"code":"4100081060","type":"CDM"},{"code":"320","type":"RC"},{"code":"74740","type":"HCPCS"}],"standard_charges":[{"gross_charge":769.37,"discounted_cash":538.56,"setting":"both","modifiers":"TC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CATHETER FOR HYSTEROGRAPHY","code_information":[{"code":"4100081065","type":"CDM"},{"code":"361","type":"RC"},{"code":"58340","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.06,"discounted_cash":51.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"RETROGRADE URETHOGRAM","code_information":[{"code":"4100081080","type":"CDM"},{"code":"320","type":"RC"},{"code":"74450","type":"HCPCS"}],"standard_charges":[{"gross_charge":371.32,"discounted_cash":259.92,"setting":"both","modifiers":"TC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"MYELOGRAPHY;C SPINE;RADIOL S&I","code_information":[{"code":"4100081205","type":"CDM"},{"code":"320","type":"RC"},{"code":"72240","type":"HCPCS"}],"standard_charges":[{"gross_charge":1792.29,"discounted_cash":1254.60,"setting":"both","modifiers":"TC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"MYELOGRAPHY LS SPINE RADIO S&I","code_information":[{"code":"410008120A","type":"CDM"},{"code":"320","type":"RC"},{"code":"72265","type":"HCPCS"}],"standard_charges":[{"gross_charge":1792.29,"discounted_cash":1254.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"INJECTION FOR MYELOGRAM","code_information":[{"code":"410008120B","type":"CDM"},{"code":"361","type":"RC"},{"code":"62284","type":"HCPCS"}],"standard_charges":[{"gross_charge":789.55,"discounted_cash":552.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"OSSEOUS SURVEY LIMITED","code_information":[{"code":"4100091020","type":"CDM"},{"code":"320","type":"RC"},{"code":"77074","type":"HCPCS"}],"standard_charges":[{"gross_charge":563.81,"discounted_cash":394.67,"setting":"both","modifiers":"TC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"INFANT BONE SURVEY","code_information":[{"code":"4100091120","type":"CDM"},{"code":"320","type":"RC"},{"code":"77076","type":"HCPCS"}],"standard_charges":[{"gross_charge":312.43,"discounted_cash":218.70,"setting":"both","modifiers":"TC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"JOINT SURVEY SINGLE VW 2+ JTS","code_information":[{"code":"4100091130","type":"CDM"},{"code":"320","type":"RC"},{"code":"77077","type":"HCPCS"}],"standard_charges":[{"gross_charge":312.43,"discounted_cash":218.70,"setting":"both","modifiers":"TC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"LOOPOGRAM-ANTEGRADE PYELOGRAM","code_information":[{"code":"4100091140","type":"CDM"},{"code":"320","type":"RC"},{"code":"74425","type":"HCPCS"}],"standard_charges":[{"gross_charge":472.2,"discounted_cash":330.54,"setting":"both","modifiers":"TC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CYSTOGRAPHY","code_information":[{"code":"410009120A","type":"CDM"},{"code":"320","type":"RC"},{"code":"74430","type":"HCPCS"}],"standard_charges":[{"gross_charge":599.8,"discounted_cash":419.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"INJECTION FOR CYSTOGRAPHY","code_information":[{"code":"410009120B","type":"CDM"},{"code":"361","type":"RC"},{"code":"51600","type":"HCPCS"}],"standard_charges":[{"gross_charge":822.26,"discounted_cash":575.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"XR FOR BIOPSY SPECIMEN","code_information":[{"code":"4100091210","type":"CDM"},{"code":"320","type":"RC"},{"code":"76098","type":"HCPCS"}],"standard_charges":[{"gross_charge":561.63,"discounted_cash":393.14,"setting":"both","modifiers":"TC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"DISCOGRAM LUMBAR RAD IN PAINCL","code_information":[{"code":"4100091350","type":"CDM"},{"code":"320","type":"RC"},{"code":"72295","type":"HCPCS"}],"standard_charges":[{"gross_charge":2390.44,"discounted_cash":1673.31,"setting":"both","modifiers":"TC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"DISCOGRAM CERV/THOR;RAD PAINCL","code_information":[{"code":"4100091360","type":"CDM"},{"code":"320","type":"RC"},{"code":"72285","type":"HCPCS"}],"standard_charges":[{"gross_charge":2390.44,"discounted_cash":1673.31,"setting":"both","modifiers":"TC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"FLUOROSCOPIC GUID KYPHOPLASTY","code_information":[{"code":"4100091370","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":1037.09,"discounted_cash":725.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SPINAL PUNCTURE","code_information":[{"code":"4100091410","type":"CDM"},{"code":"361","type":"RC"}],"standard_charges":[{"gross_charge":468.38,"discounted_cash":327.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"XR FINGER(S) 2+ VWS RT","code_information":[{"code":"4100091440","type":"CDM"},{"code":"320","type":"RC"},{"code":"73140","type":"HCPCS"}],"standard_charges":[{"gross_charge":216.5,"discounted_cash":151.55,"setting":"both","modifiers":"RTTC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body) | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XR FINGER(S) 2+ VWS LT","code_information":[{"code":"4100091445","type":"CDM"},{"code":"320","type":"RC"},{"code":"73140","type":"HCPCS"}],"standard_charges":[{"gross_charge":216.5,"discounted_cash":151.55,"setting":"both","modifiers":"LTTC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body) | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XR FINGERS(S) 2 +VIEWS BIL","code_information":[{"code":"4100091446","type":"CDM"},{"code":"320","type":"RC"},{"code":"73140","type":"HCPCS"}],"standard_charges":[{"gross_charge":400.0,"discounted_cash":280.0,"setting":"both","modifiers":"50TC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XR TOE(S) 2+ VWS RT","code_information":[{"code":"4100091450","type":"CDM"},{"code":"320","type":"RC"},{"code":"73660","type":"HCPCS"}],"standard_charges":[{"gross_charge":235.0,"discounted_cash":164.5,"setting":"both","modifiers":"RTTC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body) | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XR TOE(S) 2+ VWS LT","code_information":[{"code":"4100091455","type":"CDM"},{"code":"320","type":"RC"},{"code":"73660","type":"HCPCS"}],"standard_charges":[{"gross_charge":235.0,"discounted_cash":164.5,"setting":"both","modifiers":"LTTC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body) | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"IV Push Single/Intl drug RAD","code_information":[{"code":"4100091490","type":"CDM"},{"code":"761","type":"RC"},{"code":"96374","type":"HCPCS"}],"standard_charges":[{"gross_charge":243.19,"discounted_cash":170.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"MYELOGRAPHY T-SPINE RAD S&I","code_information":[{"code":"4100091560","type":"CDM"},{"code":"320","type":"RC"},{"code":"72255","type":"HCPCS"}],"standard_charges":[{"gross_charge":1792.29,"discounted_cash":1254.60,"setting":"both","modifiers":"TC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XR ANKLE 3+ VIEWS BIL","code_information":[{"code":"4100091920","type":"CDM"},{"code":"320","type":"RC"},{"code":"73610","type":"HCPCS"}],"standard_charges":[{"gross_charge":350.0,"discounted_cash":245.0,"setting":"both","modifiers":"TC50","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities | Modifier 50: Bilateral Procedure"}]},{"description":"XR ELBOW 3+ VWS BIL","code_information":[{"code":"4100091940","type":"CDM"},{"code":"320","type":"RC"},{"code":"73080","type":"HCPCS"}],"standard_charges":[{"gross_charge":600.0,"discounted_cash":420.0,"setting":"both","modifiers":"TC50","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities | Modifier 50: Bilateral Procedure"}]},{"description":"XR FOOT COMP 3+ VWS BIL","code_information":[{"code":"4100091960","type":"CDM"},{"code":"320","type":"RC"},{"code":"73630","type":"HCPCS"}],"standard_charges":[{"gross_charge":514.0,"discounted_cash":359.8,"setting":"both","modifiers":"TC50","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities | Modifier 50: Bilateral Procedure"}]},{"description":"XR HAND 3+ VWS BIL","code_information":[{"code":"4100091980","type":"CDM"},{"code":"320","type":"RC"},{"code":"73130","type":"HCPCS"}],"standard_charges":[{"gross_charge":511.0,"discounted_cash":357.7,"setting":"both","modifiers":"TC50","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities | Modifier 50: Bilateral Procedure"}]},{"description":"XR HEEL 2+ VIEWS BIL","code_information":[{"code":"4100091990","type":"CDM"},{"code":"320","type":"RC"},{"code":"73650","type":"HCPCS"}],"standard_charges":[{"gross_charge":528.5,"discounted_cash":369.95,"setting":"both","modifiers":"TC50","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities | Modifier 50: Bilateral Procedure"}]},{"description":"XR HUMERUS  2+ VWS BIL","code_information":[{"code":"4100092020","type":"CDM"},{"code":"320","type":"RC"},{"code":"73060","type":"HCPCS"}],"standard_charges":[{"gross_charge":600.0,"discounted_cash":420.0,"setting":"both","modifiers":"TC50","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities | Modifier 50: Bilateral Procedure"}]},{"description":"XR KNEE 3 VIEWS BIL","code_information":[{"code":"4100092030","type":"CDM"},{"code":"320","type":"RC"},{"code":"73562","type":"HCPCS"}],"standard_charges":[{"gross_charge":603.0,"discounted_cash":422.1,"setting":"both","modifiers":"TC50","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities | Modifier 50: Bilateral Procedure"}]},{"description":"XR LOWER LEG 2 VW BIL","code_information":[{"code":"4100092040","type":"CDM"},{"code":"320","type":"RC"},{"code":"73590","type":"HCPCS"}],"standard_charges":[{"gross_charge":400.0,"discounted_cash":280.0,"setting":"both","modifiers":"TC50","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities | Modifier 50: Bilateral Procedure"}]},{"description":"XR KNEE  1-2VWS BIL","code_information":[{"code":"4100092050","type":"CDM"},{"code":"320","type":"RC"},{"code":"73560","type":"HCPCS"}],"standard_charges":[{"gross_charge":643.5,"discounted_cash":450.45,"setting":"both","modifiers":"TC50","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities | Modifier 50: Bilateral Procedure"}]},{"description":"XR WRIST 3+ VIEW BIL","code_information":[{"code":"4100092060","type":"CDM"},{"code":"320","type":"RC"},{"code":"73110","type":"HCPCS"}],"standard_charges":[{"gross_charge":511.0,"discounted_cash":357.7,"setting":"both","modifiers":"TC50","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities | Modifier 50: Bilateral Procedure"}]},{"description":"MYELOGRAPHY TWO OR MORE AREAS","code_information":[{"code":"4100092070","type":"CDM"},{"code":"320","type":"RC"},{"code":"72270","type":"HCPCS"}],"standard_charges":[{"gross_charge":1920.43,"discounted_cash":1344.30,"setting":"both","modifiers":"TC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XR SHOULDER 2+ VWS BIL","code_information":[{"code":"4100092090","type":"CDM"},{"code":"320","type":"RC"},{"code":"73030","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":499.8,"setting":"both","modifiers":"TC50","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities | Modifier 50: Bilateral Procedure"}]},{"description":"FLUORO GUIDED SPINE INJECTION","code_information":[{"code":"4100092110","type":"CDM"},{"code":"320","type":"RC"},{"code":"77003","type":"HCPCS"}],"standard_charges":[{"gross_charge":287.35,"discounted_cash":201.14,"setting":"both","modifiers":"TC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"RADIOLOGIC GUIDED GU DILATION","code_information":[{"code":"4100092130","type":"CDM"},{"code":"320","type":"RC"},{"code":"74485","type":"HCPCS"}],"standard_charges":[{"gross_charge":2401.89,"discounted_cash":1681.32,"setting":"both","modifiers":"TC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"MAMMARY DUCTOGRAM","code_information":[{"code":"4100092160","type":"CDM"},{"code":"320","type":"RC"},{"code":"77053","type":"HCPCS"}],"standard_charges":[{"gross_charge":551.8,"discounted_cash":386.26,"setting":"both","modifiers":"TC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"DUCTOGRAM INJECTION","code_information":[{"code":"4100092170","type":"CDM"},{"code":"361","type":"RC"},{"code":"19030","type":"HCPCS"}],"standard_charges":[{"gross_charge":398.04,"discounted_cash":278.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"MAMMARY DUCTOGRAM MULTIPLE","code_information":[{"code":"4100092190","type":"CDM"},{"code":"320","type":"RC"},{"code":"77054","type":"HCPCS"}],"standard_charges":[{"gross_charge":642.33,"discounted_cash":449.63,"setting":"both","modifiers":"TC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XR RIBS 2 VWS W/O CHEST LT","code_information":[{"code":"4100092210","type":"CDM"},{"code":"320","type":"RC"},{"code":"71100","type":"HCPCS"}],"standard_charges":[{"gross_charge":257.5,"discounted_cash":180.25,"setting":"both","modifiers":"LTTC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body) | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XR RIBS 2 VWS W/O CHEST RT","code_information":[{"code":"4100092220","type":"CDM"},{"code":"320","type":"RC"},{"code":"71100","type":"HCPCS"}],"standard_charges":[{"gross_charge":257.5,"discounted_cash":180.25,"setting":"both","modifiers":"RTTC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body) | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XR RIBS 3 VWS W/O CHEST","code_information":[{"code":"4100092230","type":"CDM"},{"code":"320","type":"RC"},{"code":"71110","type":"HCPCS"}],"standard_charges":[{"gross_charge":417.67,"discounted_cash":292.37,"setting":"both","modifiers":"TC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XR SPINE THORACIC MIN 4 VWS","code_information":[{"code":"4100092280","type":"CDM"},{"code":"320","type":"RC"},{"code":"72074","type":"HCPCS"}],"standard_charges":[{"gross_charge":421.0,"discounted_cash":294.7,"setting":"both","modifiers":"TC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XR SPINE THORACIC 2 VIEWS","code_information":[{"code":"4100092310","type":"CDM"},{"code":"320","type":"RC"},{"code":"72070","type":"HCPCS"}],"standard_charges":[{"gross_charge":286.5,"discounted_cash":200.55,"setting":"both","modifiers":"TC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XR MANDIBLE PARTIAL < 4 VWS","code_information":[{"code":"4100092320","type":"CDM"},{"code":"320","type":"RC"},{"code":"70100","type":"HCPCS"}],"standard_charges":[{"gross_charge":290.09,"discounted_cash":203.06,"setting":"both","modifiers":"TC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"REPLACE G/C TUBE PERC W/FLUORO","code_information":[{"code":"4100092350","type":"CDM"},{"code":"361","type":"RC"},{"code":"49450","type":"HCPCS"}],"standard_charges":[{"gross_charge":1083.44,"discounted_cash":758.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"RETROGRADE PYELOGRAM BILAT","code_information":[{"code":"4100092380","type":"CDM"},{"code":"320","type":"RC"},{"code":"74420","type":"HCPCS"}],"standard_charges":[{"gross_charge":1060.0,"discounted_cash":742.0,"setting":"both","modifiers":"TC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XR HUMERUS 1 VIEW","code_information":[{"code":"4100092440","type":"CDM"},{"code":"320","type":"RC"},{"code":"73060","type":"HCPCS"}],"standard_charges":[{"gross_charge":323.0,"discounted_cash":226.1,"setting":"both","modifiers":"TC52","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities | Modifier 52: Reduced Services"}]},{"description":"XR SCAPULA COMP. BIL.","code_information":[{"code":"4100092450","type":"CDM"},{"code":"320","type":"RC"},{"code":"73010","type":"HCPCS"}],"standard_charges":[{"gross_charge":735.5,"discounted_cash":514.85,"setting":"both","modifiers":"TC50","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities | Modifier 50: Bilateral Procedure"}]},{"description":"XR FOOT 2 VWS BIL","code_information":[{"code":"4100092460","type":"CDM"},{"code":"320","type":"RC"},{"code":"73620","type":"HCPCS"}],"standard_charges":[{"gross_charge":420.0,"discounted_cash":294.0,"setting":"both","modifiers":"TC50","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities | Modifier 50: Bilateral Procedure"}]},{"description":"XR FOREARM 1 VIEW","code_information":[{"code":"4100092480","type":"CDM"},{"code":"320","type":"RC"},{"code":"73090","type":"HCPCS"}],"standard_charges":[{"gross_charge":308.0,"discounted_cash":215.6,"setting":"both","modifiers":"TC52","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities | Modifier 52: Reduced Services"}]},{"description":"XR KNEES 4+ VWS BIL","code_information":[{"code":"4100092490","type":"CDM"},{"code":"320","type":"RC"},{"code":"73564","type":"HCPCS"}],"standard_charges":[{"gross_charge":803.5,"discounted_cash":562.45,"setting":"both","modifiers":"TC50","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities | Modifier 50: Bilateral Procedure"}]},{"description":"FLUOROSCOPY LIMITED","code_information":[{"code":"4100092500","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":290.09,"discounted_cash":203.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"XR HAND 2 VWS BIL","code_information":[{"code":"4100092530","type":"CDM"},{"code":"320","type":"RC"},{"code":"73120","type":"HCPCS"}],"standard_charges":[{"gross_charge":487.0,"discounted_cash":340.9,"setting":"both","modifiers":"TC50","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities | Modifier 50: Bilateral Procedure"}]},{"description":"XR ELBOW 2 VWS BIL","code_information":[{"code":"4100092560","type":"CDM"},{"code":"320","type":"RC"},{"code":"73070","type":"HCPCS"}],"standard_charges":[{"gross_charge":400.0,"discounted_cash":280.0,"setting":"both","modifiers":"TC50","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities | Modifier 50: Bilateral Procedure"}]},{"description":"XR ANKLES 2 VWS BIL","code_information":[{"code":"4100092620","type":"CDM"},{"code":"320","type":"RC"},{"code":"73600","type":"HCPCS"}],"standard_charges":[{"gross_charge":400.0,"discounted_cash":280.0,"setting":"both","modifiers":"TC50","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities | Modifier 50: Bilateral Procedure"}]},{"description":"BX BREAST 1ST LESION STEREO RT","code_information":[{"code":"4100092660","type":"CDM"},{"code":"361","type":"RC"},{"code":"19081","type":"HCPCS"}],"standard_charges":[{"gross_charge":1984.22,"discounted_cash":1388.95,"setting":"both","modifiers":"RTTC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body) | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"BX BREAST EA+ LESION STEREO RT","code_information":[{"code":"4100092670","type":"CDM"},{"code":"361","type":"RC"},{"code":"19082","type":"HCPCS"}],"standard_charges":[{"gross_charge":595.98,"discounted_cash":417.19,"setting":"both","modifiers":"RTTC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body) | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"BX BREAST EA + LESION US IM RT","code_information":[{"code":"4100092680","type":"CDM"},{"code":"361","type":"RC"},{"code":"19084","type":"HCPCS"}],"standard_charges":[{"gross_charge":1558.37,"discounted_cash":1090.86,"setting":"both","modifiers":"RTTC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body) | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"BX BREAST 1ST LESION STEREO LT","code_information":[{"code":"4100092700","type":"CDM"},{"code":"361","type":"RC"},{"code":"19081","type":"HCPCS"}],"standard_charges":[{"gross_charge":1984.22,"discounted_cash":1388.95,"setting":"both","modifiers":"LTTC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body) | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"BX BREAST EA+ LESION STEREO LT","code_information":[{"code":"4100092710","type":"CDM"},{"code":"361","type":"RC"},{"code":"19082","type":"HCPCS"}],"standard_charges":[{"gross_charge":595.98,"discounted_cash":417.19,"setting":"both","modifiers":"LTTC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body) | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"BX BREAST EA + LESION US IM LT","code_information":[{"code":"4100092720","type":"CDM"},{"code":"320","type":"RC"},{"code":"19084","type":"HCPCS"}],"standard_charges":[{"gross_charge":1558.37,"discounted_cash":1090.86,"setting":"both","modifiers":"LTTC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body) | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"BX BREAST 1ST LESION US IM LT","code_information":[{"code":"4100092730","type":"CDM"},{"code":"361","type":"RC"},{"code":"19083","type":"HCPCS"}],"standard_charges":[{"gross_charge":2429.16,"discounted_cash":1700.41,"setting":"both","modifiers":"LTTC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body) | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"BX BREAST 1ST LESION US IM RT","code_information":[{"code":"4100092740","type":"CDM"},{"code":"361","type":"RC"},{"code":"19083","type":"HCPCS"}],"standard_charges":[{"gross_charge":2429.16,"discounted_cash":1700.41,"setting":"both","modifiers":"RTTC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body) | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XR SPINE ENTIRE 2-3 VWS","code_information":[{"code":"4100092760","type":"CDM"},{"code":"320","type":"RC"},{"code":"72082","type":"HCPCS"}],"standard_charges":[{"gross_charge":287.35,"discounted_cash":201.14,"setting":"both","modifiers":"TC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"INJECTION FISTULA/SINUS TRACT","code_information":[{"code":"4100092800","type":"CDM"},{"code":"361","type":"RC"},{"code":"20501","type":"HCPCS"}],"standard_charges":[{"gross_charge":655.41,"discounted_cash":458.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Myelography Cerv. w/lumbar inj","code_information":[{"code":"4100092810","type":"CDM"},{"code":"361","type":"RC"},{"code":"62302","type":"HCPCS"}],"standard_charges":[{"gross_charge":1472.22,"discounted_cash":1030.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"THORACIC MYELOGRAPHY","code_information":[{"code":"4100092820","type":"CDM"},{"code":"361","type":"RC"},{"code":"62303","type":"HCPCS"}],"standard_charges":[{"gross_charge":1428.05,"discounted_cash":999.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LUMBAR MYELOGRAPHY","code_information":[{"code":"4100092830","type":"CDM"},{"code":"361","type":"RC"},{"code":"62304","type":"HCPCS"}],"standard_charges":[{"gross_charge":1428.05,"discounted_cash":999.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"MYELOGRAPY 2 OR MORE LEVELS","code_information":[{"code":"4100092840","type":"CDM"},{"code":"361","type":"RC"},{"code":"62305","type":"HCPCS"}],"standard_charges":[{"gross_charge":1784.66,"discounted_cash":1249.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"XR SPINE ENTIRE 4-5 VWS","code_information":[{"code":"4100092860","type":"CDM"},{"code":"320","type":"RC"},{"code":"72083","type":"HCPCS"}],"standard_charges":[{"gross_charge":322.5,"discounted_cash":225.75,"setting":"both","modifiers":"TC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XR HIP 1 VW W/WO PELVIS RT","code_information":[{"code":"4100092870","type":"CDM"},{"code":"320","type":"RC"},{"code":"73501","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.5,"discounted_cash":122.85,"setting":"both","modifiers":"RTTC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body) | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XR HIP 1 VW W/WO PELVIS LT","code_information":[{"code":"4100092880","type":"CDM"},{"code":"320","type":"RC"},{"code":"73501","type":"HCPCS"}],"standard_charges":[{"gross_charge":173.5,"discounted_cash":121.45,"setting":"both","modifiers":"LTTC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body) | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XR HIP 2-3 VW W/WO PELVIS RT","code_information":[{"code":"4100092890","type":"CDM"},{"code":"320","type":"RC"},{"code":"73502","type":"HCPCS"}],"standard_charges":[{"gross_charge":253.5,"discounted_cash":177.45,"setting":"both","modifiers":"RTTC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body) | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XR HIP 2-3 VW W/WO PELVIS LT","code_information":[{"code":"4100092900","type":"CDM"},{"code":"320","type":"RC"},{"code":"73502","type":"HCPCS"}],"standard_charges":[{"gross_charge":253.5,"discounted_cash":177.45,"setting":"both","modifiers":"LTTC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body) | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XR FEMUR 1 VIEW RT","code_information":[{"code":"4100092920","type":"CDM"},{"code":"320","type":"RC"},{"code":"73551","type":"HCPCS"}],"standard_charges":[{"gross_charge":270.5,"discounted_cash":189.35,"setting":"both","modifiers":"RTTC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body) | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Transplant Or Implant Of Heart Assist System Without Mcc","code_information":[{"code":"002","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":50993.1,"maximum":50993.1,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50993.1},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":50993.1}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major","code_information":[{"code":"003","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":95513.4,"maximum":95513.4,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":95513.4},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":95513.4}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R.","code_information":[{"code":"004","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":62331.3,"maximum":62331.3,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62331.3},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":62331.3}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Liver Transplant With Mcc Or Intestinal Transplant","code_information":[{"code":"005","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":46397.25,"maximum":46397.25,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46397.25},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":46397.25}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Liver Transplant Without Mcc","code_information":[{"code":"006","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20866.5,"maximum":20866.5,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20866.5},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":20866.5}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lung Transplant","code_information":[{"code":"007","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":58275.9,"maximum":58275.9,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58275.9},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":58275.9}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simultaneous Pancreas And Kidney Transplant","code_information":[{"code":"008","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25220.7,"maximum":25220.7,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25220.7},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":25220.7}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pancreas Transplant","code_information":[{"code":"010","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32290.65,"maximum":32290.65,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32290.65},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":32290.65}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc","code_information":[{"code":"011","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24543.45,"maximum":24543.45,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24543.45},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":24543.45}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc","code_information":[{"code":"012","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18972.0,"maximum":18972.0,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18972.0},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":18972.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/Mcc","code_information":[{"code":"013","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12968.1,"maximum":12968.1,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12968.1},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":12968.1}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Allogeneic Bone Marrow Transplant","code_information":[{"code":"014","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":54080.55,"maximum":54080.55,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54080.55},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":54080.55}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Autologous Bone Marrow Transplant With Cc/Mcc","code_information":[{"code":"016","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26683.65,"maximum":26683.65,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26683.65},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":26683.65}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Autologous Bone Marrow Transplant Without Cc/Mcc","code_information":[{"code":"017","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24445.35,"maximum":24445.35,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24445.35},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":24445.35}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chimeric Antigen Receptor (Car) T-Cell And Other Immunotherapies","code_information":[{"code":"018","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":194322.6,"maximum":194322.6,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194322.6},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":194322.6}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simultaneous Pancreas And Kidney Transplant With Hemodialysis","code_information":[{"code":"019","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32105.7,"maximum":32105.7,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32105.7},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":32105.7}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc","code_information":[{"code":"020","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":35409.6,"maximum":35409.6,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35409.6},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":35409.6}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc","code_information":[{"code":"021","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23822.1,"maximum":23822.1,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23822.1},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":23822.1}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/Mcc","code_information":[{"code":"022","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14298.3,"maximum":14298.3,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14298.3},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":14298.3}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With Mcc Or Antineopla","code_information":[{"code":"023","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25786.35,"maximum":25786.35,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25786.35},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":25786.35}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without Mcc","code_information":[{"code":"024","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17603.55,"maximum":17603.55,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17603.55},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":17603.55}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy And Endovascular Intracranial Procedures With Mcc","code_information":[{"code":"025","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20460.15,"maximum":20460.15,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20460.15},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":20460.15}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy And Endovascular Intracranial Procedures With Cc","code_information":[{"code":"026","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13991.4,"maximum":13991.4,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13991.4},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":13991.4}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy And Endovascular Intracranial Procedures Without Cc/Mcc","code_information":[{"code":"027","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11353.05,"maximum":11353.05,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11353.05},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":11353.05}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures With Mcc","code_information":[{"code":"028","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27037.35,"maximum":27037.35,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27037.35},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":27037.35}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures With Cc Or Spinal Neurostimulators","code_information":[{"code":"029","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15352.2,"maximum":15352.2,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15352.2},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":15352.2}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures Without Cc/Mcc","code_information":[{"code":"030","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9878.4,"maximum":9878.4,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9878.4},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":9878.4}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular Shunt Procedures With Mcc","code_information":[{"code":"031","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20162.25,"maximum":20162.25,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20162.25},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":20162.25}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular Shunt Procedures With Cc","code_information":[{"code":"032","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9589.5,"maximum":9589.5,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9589.5},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":9589.5}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular Shunt Procedures Without Cc/Mcc","code_information":[{"code":"033","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7483.05,"maximum":7483.05,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7483.05},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7483.05}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Carotid Artery Stent Procedures With Mcc","code_information":[{"code":"034","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17418.15,"maximum":17418.15,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17418.15},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":17418.15}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Carotid Artery Stent Procedures With Cc","code_information":[{"code":"035","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10757.25,"maximum":10757.25,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10757.25},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":10757.25}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Carotid Artery Stent Procedures Without Cc/Mcc","code_information":[{"code":"036","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8742.6,"maximum":8742.6,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8742.6},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":8742.6}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extracranial Procedures With Mcc","code_information":[{"code":"037","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14814.45,"maximum":14814.45,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14814.45},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":14814.45}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extracranial Procedures With Cc","code_information":[{"code":"038","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7301.7,"maximum":7301.7,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7301.7},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7301.7}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extracranial Procedures Without Cc/Mcc","code_information":[{"code":"039","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5289.75,"maximum":5289.75,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5289.75},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":5289.75}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc","code_information":[{"code":"040","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17375.4,"maximum":17375.4,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17375.4},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":17375.4}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator","code_information":[{"code":"041","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9894.15,"maximum":9894.15,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9894.15},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":9894.15}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/Mcc","code_information":[{"code":"042","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7774.65,"maximum":7774.65,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7774.65},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7774.65}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Disorders And Injuries With Cc/Mcc","code_information":[{"code":"052","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8150.85,"maximum":8150.85,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8150.85},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":8150.85}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Disorders And Injuries Without Cc/Mcc","code_information":[{"code":"053","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4406.4,"maximum":4406.4,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4406.4},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":4406.4}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Nervous System Neoplasms With Mcc","code_information":[{"code":"054","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6871.05,"maximum":6871.05,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6871.05},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6871.05}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Nervous System Neoplasms Without Mcc","code_information":[{"code":"055","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4588.2,"maximum":4588.2,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4588.2},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":4588.2}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Degenerative Nervous System Disorders With Mcc","code_information":[{"code":"056","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10453.95,"maximum":10453.95,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10453.95},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":10453.95}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Degenerative Nervous System Disorders Without Mcc","code_information":[{"code":"057","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5830.2,"maximum":5830.2,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5830.2},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":5830.2}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"1 through 10","median_amount":23425.5,"10th_percentile":23425.5,"90th_percentile":23425.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"1 through 10","median_amount":22562.14,"10th_percentile":22562.14,"90th_percentile":22562.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"1 through 10","median_amount":6721.25,"10th_percentile":6721.25,"90th_percentile":6721.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"1 through 10","median_amount":7677.25,"10th_percentile":7677.25,"90th_percentile":7677.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Sclerosis And Cerebellar Ataxia With Mcc","code_information":[{"code":"058","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7692.75,"maximum":7692.75,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7692.75},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7692.75}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Sclerosis And Cerebellar Ataxia With Cc","code_information":[{"code":"059","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5584.05,"maximum":5584.05,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5584.05},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":5584.05}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc","code_information":[{"code":"060","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4139.1,"maximum":4139.1,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4139.1},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":4139.1}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Mcc","code_information":[{"code":"061","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12406.95,"maximum":12406.95,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12406.95},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":12406.95}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc","code_information":[{"code":"062","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7907.4,"maximum":7907.4,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7907.4},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7907.4}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/Mcc","code_information":[{"code":"063","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6317.1,"maximum":6317.1,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6317.1},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6317.1}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Hemorrhage Or Cerebral Infarction With Mcc","code_information":[{"code":"064","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9049.5,"maximum":9049.5,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9049.5},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":9049.5}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours","code_information":[{"code":"065","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4546.35,"maximum":4546.35,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4546.35},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":4546.35}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":3247.9,"10th_percentile":3247.9,"90th_percentile":3247.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"1 through 10","median_amount":7199.42,"10th_percentile":7199.42,"90th_percentile":7199.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc","code_information":[{"code":"066","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3079.8,"maximum":3079.8,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3079.8},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":3079.8}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Precerebral Occlusion Without Infarction With Mcc","code_information":[{"code":"067","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6609.15,"maximum":6609.15,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6609.15},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6609.15}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Precerebral Occlusion Without Infarction Without Mcc","code_information":[{"code":"068","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3889.8,"maximum":3889.8,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3889.8},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":3889.8}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transient Ischemia Without Thrombolytic","code_information":[{"code":"069","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3594.6,"maximum":3594.6,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3594.6},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":3594.6}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"1 through 10","median_amount":3221.76,"10th_percentile":3221.76,"90th_percentile":3221.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cerebrovascular Disorders With Mcc","code_information":[{"code":"070","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7491.6,"maximum":7491.6,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7491.6},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7491.6}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cerebrovascular Disorders With Cc","code_information":[{"code":"071","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4617.0,"maximum":4617.0,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4617.0},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":4617.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cerebrovascular Disorders Without Cc/Mcc","code_information":[{"code":"072","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3402.9,"maximum":3402.9,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3402.9},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":3402.9}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cranial And Peripheral Nerve Disorders With Mcc","code_information":[{"code":"073","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7219.35,"maximum":7219.35,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7219.35},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7219.35}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cranial And Peripheral Nerve Disorders Without Mcc","code_information":[{"code":"074","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4638.6,"maximum":4638.6,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4638.6},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":4638.6}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Viral Meningitis With Cc/Mcc","code_information":[{"code":"075","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8628.75,"maximum":8628.75,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8628.75},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":8628.75}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Viral Meningitis Without Cc/Mcc","code_information":[{"code":"076","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3713.4,"maximum":3713.4,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3713.4},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":3713.4}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Nontraumatic Stupor And Coma With Mcc","code_information":[{"code":"080","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8145.0,"maximum":8145.0,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8145.0},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":8145.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Nontraumatic Stupor And Coma Without Mcc","code_information":[{"code":"081","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4030.2,"maximum":4030.2,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4030.2},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":4030.2}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma >1 Hour With Mcc","code_information":[{"code":"082","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10285.2,"maximum":10285.2,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10285.2},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":10285.2}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma >1 Hour With Cc","code_information":[{"code":"083","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6281.1,"maximum":6281.1,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6281.1},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6281.1}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma >1 Hour Without Cc/Mcc","code_information":[{"code":"084","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4301.1,"maximum":4301.1,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4301.1},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":4301.1}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma <1 Hour With Mcc","code_information":[{"code":"085","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10223.55,"maximum":10223.55,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10223.55},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":10223.55}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma <1 Hour With Cc","code_information":[{"code":"086","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5862.15,"maximum":5862.15,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5862.15},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":5862.15}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma <1 Hour Without Cc/Mcc","code_information":[{"code":"087","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4116.15,"maximum":4116.15,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4116.15},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":4116.15}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concussion With Mcc","code_information":[{"code":"088","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6083.1,"maximum":6083.1,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6083.1},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6083.1}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concussion With Cc","code_information":[{"code":"089","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4943.7,"maximum":4943.7,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4943.7},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":4943.7}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concussion Without Cc/Mcc","code_information":[{"code":"090","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3704.4,"maximum":3704.4,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3704.4},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":3704.4}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of Nervous System With Mcc","code_information":[{"code":"091","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7902.9,"maximum":7902.9,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7902.9},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7902.9}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of Nervous System With Cc","code_information":[{"code":"092","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4603.5,"maximum":4603.5,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4603.5},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":4603.5}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of Nervous System Without Cc/Mcc","code_information":[{"code":"093","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3583.35,"maximum":3583.35,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3583.35},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":3583.35}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bacterial And Tuberculous Infections Of Nervous System With Mcc","code_information":[{"code":"094","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15837.3,"maximum":15837.3,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15837.3},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":15837.3}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bacterial And Tuberculous Infections Of Nervous System With Cc","code_information":[{"code":"095","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11606.4,"maximum":11606.4,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11606.4},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":11606.4}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc","code_information":[{"code":"096","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11606.4,"maximum":11606.4,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11606.4},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":11606.4}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Mcc","code_information":[{"code":"097","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16253.1,"maximum":16253.1,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16253.1},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":16253.1}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc","code_information":[{"code":"098","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10327.05,"maximum":10327.05,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10327.05},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":10327.05}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/Mcc","code_information":[{"code":"099","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6130.8,"maximum":6130.8,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6130.8},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6130.8}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Seizures With Mcc","code_information":[{"code":"100","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8715.6,"maximum":8715.6,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8715.6},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":8715.6}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Seizures Without Mcc","code_information":[{"code":"101","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4061.7,"maximum":4061.7,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4061.7},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":4061.7}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Headaches With Mcc","code_information":[{"code":"102","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5044.05,"maximum":5044.05,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5044.05},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":5044.05}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Headaches Without Mcc","code_information":[{"code":"103","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3763.35,"maximum":3763.35,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3763.35},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":3763.35}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Orbital Procedures With Cc/Mcc","code_information":[{"code":"113","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10579.95,"maximum":10579.95,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10579.95},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":10579.95}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Orbital Procedures Without Cc/Mcc","code_information":[{"code":"114","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6088.5,"maximum":6088.5,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6088.5},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6088.5}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extraocular Procedures Except Orbit","code_information":[{"code":"115","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6907.05,"maximum":6907.05,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6907.05},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6907.05}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intraocular Procedures With Cc/Mcc","code_information":[{"code":"116","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8136.45,"maximum":8136.45,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8136.45},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":8136.45}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intraocular Procedures Without Cc/Mcc","code_information":[{"code":"117","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4882.05,"maximum":4882.05,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4882.05},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":4882.05}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Major Eye Infections With Cc/Mcc","code_information":[{"code":"121","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5234.85,"maximum":5234.85,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5234.85},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":5234.85}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Major Eye Infections Without Cc/Mcc","code_information":[{"code":"122","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3536.1,"maximum":3536.1,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3536.1},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":3536.1}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neurological Eye Disorders","code_information":[{"code":"123","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3593.7,"maximum":3593.7,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3593.7},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":3593.7}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of The Eye With Mcc Or Thrombolytic Agent","code_information":[{"code":"124","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5953.95,"maximum":5953.95,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5953.95},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":5953.95}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of The Eye Without Mcc","code_information":[{"code":"125","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3455.1,"maximum":3455.1,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3455.1},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":3455.1}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sinus And Mastoid Procedures With Cc/Mcc","code_information":[{"code":"135","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9765.0,"maximum":9765.0,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9765.0},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":9765.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sinus And Mastoid Procedures Without Cc/Mcc","code_information":[{"code":"136","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4568.85,"maximum":4568.85,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4568.85},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":4568.85}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mouth Procedures With Cc/Mcc","code_information":[{"code":"137","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6719.4,"maximum":6719.4,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6719.4},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6719.4}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mouth Procedures Without Cc/Mcc","code_information":[{"code":"138","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3987.9,"maximum":3987.9,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3987.9},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":3987.9}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Salivary Gland Procedures","code_information":[{"code":"139","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5560.65,"maximum":5560.65,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5560.65},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":5560.65}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head And Neck Procedures With Mcc","code_information":[{"code":"140","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19193.85,"maximum":19193.85,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19193.85},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":19193.85}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head And Neck Procedures With Cc","code_information":[{"code":"141","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9814.95,"maximum":9814.95,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9814.95},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":9814.95}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head And Neck Procedures Without Cc/Mcc","code_information":[{"code":"142","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7183.8,"maximum":7183.8,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7183.8},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7183.8}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Procedures With Mcc","code_information":[{"code":"143","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16859.7,"maximum":16859.7,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16859.7},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":16859.7}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat O.R. Procedures With Cc","code_information":[{"code":"144","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7798.05,"maximum":7798.05,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7798.05},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7798.05}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat O.R. Procedures Without Cc/Mcc","code_information":[{"code":"145","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5410.35,"maximum":5410.35,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5410.35},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":5410.35}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ear, Nose, Mouth And Throat Malignancy With Mcc","code_information":[{"code":"146","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9528.3,"maximum":9528.3,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9528.3},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":9528.3}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ear, Nose, Mouth And Throat Malignancy With Cc","code_information":[{"code":"147","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5721.75,"maximum":5721.75,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5721.75},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":5721.75}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ear, Nose, Mouth And Throat Malignancy Without Cc/Mcc","code_information":[{"code":"148","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3586.95,"maximum":3586.95,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3586.95},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":3586.95}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dysequilibrium","code_information":[{"code":"149","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3382.2,"maximum":3382.2,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3382.2},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":3382.2}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Epistaxis With Mcc","code_information":[{"code":"150","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5991.75,"maximum":5991.75,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5991.75},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":5991.75}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Epistaxis Without Mcc","code_information":[{"code":"151","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3303.0,"maximum":3303.0,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3303.0},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":3303.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Otitis Media And Uri With Mcc","code_information":[{"code":"152","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5319.9,"maximum":5319.9,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5319.9},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":5319.9}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Otitis Media And Uri Without Mcc","code_information":[{"code":"153","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3321.9,"maximum":3321.9,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3321.9},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":3321.9}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat Diagnoses With Mcc","code_information":[{"code":"154","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7035.75,"maximum":7035.75,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7035.75},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7035.75}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat Diagnoses With Cc","code_information":[{"code":"155","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4124.25,"maximum":4124.25,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4124.25},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":4124.25}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/Mcc","code_information":[{"code":"156","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3109.95,"maximum":3109.95,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3109.95},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":3109.95}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dental And Oral Diseases With Mcc","code_information":[{"code":"157","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7725.6,"maximum":7725.6,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7725.6},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7725.6}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dental And Oral Diseases With Cc","code_information":[{"code":"158","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4094.1,"maximum":4094.1,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4094.1},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":4094.1}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dental And Oral Diseases Without Cc/Mcc","code_information":[{"code":"159","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3188.25,"maximum":3188.25,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3188.25},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":3188.25}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Procedures With Mcc","code_information":[{"code":"163","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20168.1,"maximum":20168.1,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20168.1},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":20168.1}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Procedures With Cc","code_information":[{"code":"164","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11358.0,"maximum":11358.0,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11358.0},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":11358.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Procedures Without Cc/Mcc","code_information":[{"code":"165","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8613.9,"maximum":8613.9,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8613.9},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":8613.9}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Procedures With Mcc","code_information":[{"code":"166","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16819.65,"maximum":16819.65,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16819.65},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":16819.65}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Procedures With Cc","code_information":[{"code":"167","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8115.3,"maximum":8115.3,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8115.3},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":8115.3}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Procedures Without Cc/Mcc","code_information":[{"code":"168","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6148.8,"maximum":6148.8,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6148.8},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6148.8}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary Embolism","code_information":[{"code":"173","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13393.8,"maximum":13393.8,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13393.8},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":13393.8}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pulmonary Embolism With Mcc Or Acute Cor Pulmonale","code_information":[{"code":"175","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6181.2,"maximum":6181.2,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6181.2},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6181.2}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pulmonary Embolism Without Mcc","code_information":[{"code":"176","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3622.5,"maximum":3622.5,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3622.5},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":3622.5}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Infections And Inflammations With Mcc","code_information":[{"code":"177","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7032.15,"maximum":7032.15,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7032.15},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7032.15}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Infections And Inflammations With Cc","code_information":[{"code":"178","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4392.0,"maximum":4392.0,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4392.0},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":4392.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Infections And Inflammations Without Cc/Mcc","code_information":[{"code":"179","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3397.5,"maximum":3397.5,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3397.5},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":3397.5}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Neoplasms With Mcc","code_information":[{"code":"180","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7947.0,"maximum":7947.0,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7947.0},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7947.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Neoplasms With Cc","code_information":[{"code":"181","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4819.5,"maximum":4819.5,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4819.5},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":4819.5}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Neoplasms Without Cc/Mcc","code_information":[{"code":"182","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3392.1,"maximum":3392.1,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3392.1},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":3392.1}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Trauma With Mcc","code_information":[{"code":"183","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6884.55,"maximum":6884.55,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6884.55},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6884.55}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Trauma With Cc","code_information":[{"code":"184","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4788.45,"maximum":4788.45,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4788.45},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":4788.45}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Trauma Without Cc/Mcc","code_information":[{"code":"185","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3539.25,"maximum":3539.25,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3539.25},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":3539.25}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pleural Effusion With Mcc","code_information":[{"code":"186","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7013.25,"maximum":7013.25,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7013.25},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7013.25}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pleural Effusion With Cc","code_information":[{"code":"187","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4450.95,"maximum":4450.95,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4450.95},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":4450.95}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pleural Effusion Without Cc/Mcc","code_information":[{"code":"188","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3227.4,"maximum":3227.4,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3227.4},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":3227.4}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pulmonary Edema And Respiratory Failure","code_information":[{"code":"189","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5559.3,"maximum":5559.3,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5559.3},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":5559.3}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":3248.78,"10th_percentile":3248.78,"90th_percentile":3248.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"1 through 10","median_amount":6379.0,"10th_percentile":6379.0,"90th_percentile":6379.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"1 through 10","median_amount":14653.92,"10th_percentile":14653.92,"90th_percentile":14653.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chronic Obstructive Pulmonary Disease With Mcc","code_information":[{"code":"190","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4984.65,"maximum":4984.65,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4984.65},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":4984.65}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":3248.78,"10th_percentile":3248.78,"90th_percentile":3248.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"1 through 10","median_amount":5514.76,"10th_percentile":5514.76,"90th_percentile":5514.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"1 through 10","median_amount":6392.02,"10th_percentile":6392.02,"90th_percentile":6392.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chronic Obstructive Pulmonary Disease With Cc","code_information":[{"code":"191","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3793.5,"maximum":3793.5,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3793.5},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":3793.5}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":3247.9,"10th_percentile":3247.9,"90th_percentile":3247.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"1 through 10","median_amount":21199.49,"10th_percentile":21199.49,"90th_percentile":21199.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chronic Obstructive Pulmonary Disease Without Cc/Mcc","code_information":[{"code":"192","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2889.0,"maximum":2889.0,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2889.0},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":2889.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"1 through 10","median_amount":650.0,"10th_percentile":650.0,"90th_percentile":650.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simple Pneumonia And Pleurisy With Mcc","code_information":[{"code":"193","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5914.8,"maximum":5914.8,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5914.8},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":5914.8}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":3248.78,"10th_percentile":3248.78,"90th_percentile":3248.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"1 through 10","median_amount":6444.92,"10th_percentile":6444.92,"90th_percentile":6444.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simple Pneumonia And Pleurisy With Cc","code_information":[{"code":"194","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3626.55,"maximum":3626.55,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3626.55},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":3626.55}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"1 through 10","median_amount":10039.5,"10th_percentile":10039.5,"90th_percentile":10039.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"1 through 10","median_amount":19184.0,"10th_percentile":19184.0,"90th_percentile":19184.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simple Pneumonia And Pleurisy Without Cc/Mcc","code_information":[{"code":"195","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2828.25,"maximum":2828.25,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2828.25},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":2828.25}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"1 through 10","median_amount":1826.55,"10th_percentile":1826.55,"90th_percentile":1826.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"1 through 10","median_amount":12892.65,"10th_percentile":12892.65,"90th_percentile":12892.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Interstitial Lung Disease With Mcc","code_information":[{"code":"196","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8492.4,"maximum":8492.4,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8492.4},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":8492.4}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Interstitial Lung Disease With Cc","code_information":[{"code":"197","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4270.95,"maximum":4270.95,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4270.95},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":4270.95}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Interstitial Lung Disease Without Cc/Mcc","code_information":[{"code":"198","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3222.9,"maximum":3222.9,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3222.9},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":3222.9}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pneumothorax With Mcc","code_information":[{"code":"199","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7938.45,"maximum":7938.45,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7938.45},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7938.45}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pneumothorax With Cc","code_information":[{"code":"200","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4946.85,"maximum":4946.85,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4946.85},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":4946.85}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pneumothorax Without Cc/Mcc","code_information":[{"code":"201","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3217.95,"maximum":3217.95,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3217.95},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":3217.95}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bronchitis And Asthma With Cc/Mcc","code_information":[{"code":"202","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4370.4,"maximum":4370.4,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4370.4},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":4370.4}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"1 through 10","median_amount":3703.65,"10th_percentile":3703.65,"90th_percentile":3703.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"1 through 10","median_amount":10796.78,"10th_percentile":10796.78,"90th_percentile":10796.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bronchitis And Asthma Without Cc/Mcc","code_information":[{"code":"203","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3015.0,"maximum":3015.0,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3015.0},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":3015.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Signs And Symptoms","code_information":[{"code":"204","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3633.3,"maximum":3633.3,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3633.3},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":3633.3}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System Diagnoses With Mcc","code_information":[{"code":"205","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8239.5,"maximum":8239.5,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8239.5},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":8239.5}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System Diagnoses Without Mcc","code_information":[{"code":"206","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4234.95,"maximum":4234.95,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4234.95},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":4234.95}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory System Diagnosis With Ventilator Support >96 Hours","code_information":[{"code":"207","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28956.15,"maximum":28956.15,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28956.15},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":28956.15}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory System Diagnosis With Ventilator Support <=96 Hours","code_information":[{"code":"208","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12369.15,"maximum":12369.15,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12369.15},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":12369.15}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complex Aortic Arch Procedures","code_information":[{"code":"209","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":50934.6,"maximum":50934.6,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50934.6},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":50934.6}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concomitant Aortic And Mitral Valve Procedures","code_information":[{"code":"212","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":48933.45,"maximum":48933.45,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48933.45},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":48933.45}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endovascular Abdominal Aorta With Iliac Branch Procedures","code_information":[{"code":"213","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25681.05,"maximum":25681.05,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25681.05},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":25681.05}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Heart Assist System Implant","code_information":[{"code":"215","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":44806.5,"maximum":44806.5,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44806.5},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":44806.5}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc","code_information":[{"code":"216","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":44022.6,"maximum":44022.6,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44022.6},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":44022.6}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc","code_information":[{"code":"217","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29588.85,"maximum":29588.85,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29588.85},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":29588.85}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/Mcc","code_information":[{"code":"218","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29588.85,"maximum":29588.85,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29588.85},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":29588.85}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc","code_information":[{"code":"219","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":34552.35,"maximum":34552.35,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34552.35},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":34552.35}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc","code_information":[{"code":"220","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23997.6,"maximum":23997.6,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23997.6},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":23997.6}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/M","code_information":[{"code":"221","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22680.9,"maximum":22680.9,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22680.9},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":22680.9}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cardiothoracic Procedures With Mcc","code_information":[{"code":"228","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22263.3,"maximum":22263.3,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22263.3},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":22263.3}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cardiothoracic Procedures Without Mcc","code_information":[{"code":"229","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14172.75,"maximum":14172.75,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14172.75},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":14172.75}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass With Ptca With Mcc","code_information":[{"code":"231","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":37934.55,"maximum":37934.55,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37934.55},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":37934.55}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass With Ptca Without Mcc","code_information":[{"code":"232","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27281.7,"maximum":27281.7,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27281.7},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":27281.7}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc","code_information":[{"code":"233","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":34403.4,"maximum":34403.4,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34403.4},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":34403.4}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc","code_information":[{"code":"234","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24582.15,"maximum":24582.15,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24582.15},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":24582.15}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass Without Cardiac Catheterization With Mcc","code_information":[{"code":"235","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26408.7,"maximum":26408.7,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26408.7},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":26408.7}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass Without Cardiac Catheterization Without Mcc","code_information":[{"code":"236","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18849.6,"maximum":18849.6,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18849.6},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":18849.6}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc","code_information":[{"code":"239","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22147.65,"maximum":22147.65,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22147.65},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":22147.65}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc","code_information":[{"code":"240","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12827.25,"maximum":12827.25,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12827.25},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":12827.25}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/Mcc","code_information":[{"code":"241","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6229.8,"maximum":6229.8,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6229.8},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6229.8}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Permanent Cardiac Pacemaker Implant With Mcc","code_information":[{"code":"242","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14367.6,"maximum":14367.6,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14367.6},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":14367.6}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Permanent Cardiac Pacemaker Implant With Cc","code_information":[{"code":"243","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9589.05,"maximum":9589.05,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9589.05},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":9589.05}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Permanent Cardiac Pacemaker Implant Without Cc/Mcc","code_information":[{"code":"244","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8133.75,"maximum":8133.75,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8133.75},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":8133.75}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aicd Generator Procedures","code_information":[{"code":"245","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20530.8,"maximum":20530.8,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20530.8},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":20530.8}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc","code_information":[{"code":"250","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9821.25,"maximum":9821.25,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9821.25},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":9821.25}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"1 through 10","median_amount":11353.46,"10th_percentile":11353.46,"90th_percentile":11353.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc","code_information":[{"code":"251","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6725.25,"maximum":6725.25,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6725.25},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6725.25}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Vascular Procedures With Mcc","code_information":[{"code":"252","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15697.35,"maximum":15697.35,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15697.35},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":15697.35}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Vascular Procedures With Cc","code_information":[{"code":"253","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11680.2,"maximum":11680.2,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11680.2},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":11680.2}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Vascular Procedures Without Cc/Mcc","code_information":[{"code":"254","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8017.65,"maximum":8017.65,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8017.65},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":8017.65}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc","code_information":[{"code":"255","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12138.3,"maximum":12138.3,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12138.3},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":12138.3}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Upper Limb And Toe Amputation For Circulatory System Disorders With Cc","code_information":[{"code":"256","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7640.55,"maximum":7640.55,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7640.55},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7640.55}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"1 through 10","median_amount":9954.67,"10th_percentile":9954.67,"90th_percentile":9954.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Upper Limb And Toe Amputation For Circulatory System Disorders Without Cc/Mcc","code_information":[{"code":"257","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4914.9,"maximum":4914.9,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4914.9},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":4914.9}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Device Replacement With Mcc","code_information":[{"code":"258","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14139.45,"maximum":14139.45,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14139.45},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":14139.45}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Device Replacement Without Mcc","code_information":[{"code":"259","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9099.45,"maximum":9099.45,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9099.45},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":9099.45}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Revision Except Device Replacement With Mcc","code_information":[{"code":"260","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14637.6,"maximum":14637.6,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14637.6},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":14637.6}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Revision Except Device Replacement With Cc","code_information":[{"code":"261","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8507.25,"maximum":8507.25,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8507.25},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":8507.25}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Revision Except Device Replacement Without Cc/Mcc","code_information":[{"code":"262","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7334.55,"maximum":7334.55,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7334.55},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7334.55}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vein Ligation And Stripping","code_information":[{"code":"263","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13758.3,"maximum":13758.3,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13758.3},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":13758.3}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System O.R. Procedures","code_information":[{"code":"264","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15032.7,"maximum":15032.7,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15032.7},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":15032.7}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aicd Lead Procedures","code_information":[{"code":"265","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16281.9,"maximum":16281.9,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16281.9},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":16281.9}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc","code_information":[{"code":"266","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27577.8,"maximum":27577.8,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27577.8},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":27577.8}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc","code_information":[{"code":"267","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21423.6,"maximum":21423.6,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21423.6},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":21423.6}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc","code_information":[{"code":"268","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30950.55,"maximum":30950.55,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30950.55},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":30950.55}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc","code_information":[{"code":"269","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19004.4,"maximum":19004.4,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19004.4},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":19004.4}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Major Cardiovascular Procedures With Mcc","code_information":[{"code":"270","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23743.35,"maximum":23743.35,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23743.35},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":23743.35}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Major Cardiovascular Procedures With Cc","code_information":[{"code":"271","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16003.35,"maximum":16003.35,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16003.35},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":16003.35}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Major Cardiovascular Procedures Without Cc/Mcc","code_information":[{"code":"272","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11488.5,"maximum":11488.5,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11488.5},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":11488.5}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous And Other Intracardiac Procedures With Mcc","code_information":[{"code":"273","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18564.75,"maximum":18564.75,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18564.75},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":18564.75}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous And Other Intracardiac Procedures Without Mcc","code_information":[{"code":"274","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14812.65,"maximum":14812.65,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14812.65},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":14812.65}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc","code_information":[{"code":"275","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32086.8,"maximum":32086.8,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32086.8},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":32086.8}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator","code_information":[{"code":"276","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27029.7,"maximum":27029.7,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27029.7},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":27029.7}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant Without Mcc","code_information":[{"code":"277","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20783.25,"maximum":20783.25,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20783.25},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":20783.25}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures With Mcc","code_information":[{"code":"278","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25047.9,"maximum":25047.9,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25047.9},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":25047.9}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures Without Mcc","code_information":[{"code":"279","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16228.8,"maximum":16228.8,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16228.8},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":16228.8}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Discharged Alive With Mcc","code_information":[{"code":"280","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7218.45,"maximum":7218.45,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7218.45},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7218.45}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Discharged Alive With Cc","code_information":[{"code":"281","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4135.95,"maximum":4135.95,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4135.95},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":4135.95}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"1 through 10","median_amount":3196.0,"10th_percentile":3196.0,"90th_percentile":3196.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc","code_information":[{"code":"282","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3253.95,"maximum":3253.95,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3253.95},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":3253.95}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"1 through 10","median_amount":12791.51,"10th_percentile":12791.51,"90th_percentile":12791.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"1 through 10","median_amount":6474.23,"10th_percentile":6474.23,"90th_percentile":6474.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Expired With Mcc","code_information":[{"code":"283","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8913.6,"maximum":8913.6,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8913.6},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":8913.6}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Expired With Cc","code_information":[{"code":"284","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3114.9,"maximum":3114.9,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3114.9},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":3114.9}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Expired Without Cc/Mcc","code_information":[{"code":"285","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2695.05,"maximum":2695.05,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2695.05},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":2695.05}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc","code_information":[{"code":"286","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9957.6,"maximum":9957.6,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9957.6},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":9957.6}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc","code_information":[{"code":"287","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4815.45,"maximum":4815.45,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4815.45},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":4815.45}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"1 through 10","median_amount":3224.66,"10th_percentile":3224.66,"90th_percentile":3224.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute And Subacute Endocarditis With Mcc","code_information":[{"code":"288","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12177.9,"maximum":12177.9,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12177.9},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":12177.9}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute And Subacute Endocarditis With Cc","code_information":[{"code":"289","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7681.05,"maximum":7681.05,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7681.05},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7681.05}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute And Subacute Endocarditis Without Cc/Mcc","code_information":[{"code":"290","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4183.65,"maximum":4183.65,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4183.65},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":4183.65}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Failure And Shock With Mcc","code_information":[{"code":"291","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5777.1,"maximum":5777.1,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5777.1},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":5777.1}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":9678.43,"10th_percentile":9678.43,"90th_percentile":9678.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Failure And Shock With Cc","code_information":[{"code":"292","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3820.5,"maximum":3820.5,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3820.5},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":3820.5}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":6463.16,"10th_percentile":6463.16,"90th_percentile":6463.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Failure And Shock Without Cc/Mcc","code_information":[{"code":"293","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2547.0,"maximum":2547.0,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2547.0},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":2547.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"1 through 10","median_amount":6509.18,"10th_percentile":6509.18,"90th_percentile":6509.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrest, Unexplained With Mcc","code_information":[{"code":"296","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7028.55,"maximum":7028.55,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7028.55},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7028.55}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrest, Unexplained With Cc","code_information":[{"code":"297","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2853.0,"maximum":2853.0,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2853.0},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":2853.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrest, Unexplained Without Cc/Mcc","code_information":[{"code":"298","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2047.95,"maximum":2047.95,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2047.95},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":2047.95}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral Vascular Disorders With Mcc","code_information":[{"code":"299","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7347.15,"maximum":7347.15,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7347.15},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7347.15}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"1 through 10","median_amount":3215.26,"10th_percentile":3215.26,"90th_percentile":3215.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral Vascular Disorders With Cc","code_information":[{"code":"300","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4803.75,"maximum":4803.75,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4803.75},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":4803.75}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":3355.68,"10th_percentile":3355.68,"90th_percentile":3355.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral Vascular Disorders Without Cc/Mcc","code_information":[{"code":"301","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3238.65,"maximum":3238.65,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3238.65},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":3238.65}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Atherosclerosis With Mcc","code_information":[{"code":"302","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5384.7,"maximum":5384.7,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5384.7},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":5384.7}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Atherosclerosis Without Mcc","code_information":[{"code":"303","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3029.4,"maximum":3029.4,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3029.4},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":3029.4}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertension With Mcc","code_information":[{"code":"304","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5355.0,"maximum":5355.0,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5355.0},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":5355.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertension Without Mcc","code_information":[{"code":"305","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3397.95,"maximum":3397.95,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3397.95},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":3397.95}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":4074.72,"10th_percentile":4074.72,"90th_percentile":4074.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Congenital And Valvular Disorders With Mcc","code_information":[{"code":"306","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7091.1,"maximum":7091.1,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7091.1},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7091.1}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Congenital And Valvular Disorders Without Mcc","code_information":[{"code":"307","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4109.4,"maximum":4109.4,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4109.4},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":4109.4}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrhythmia And Conduction Disorders With Mcc","code_information":[{"code":"308","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5418.0,"maximum":5418.0,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5418.0},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":5418.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"1 through 10","median_amount":13386.0,"10th_percentile":13386.0,"90th_percentile":13386.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"1 through 10","median_amount":5426.55,"10th_percentile":5426.55,"90th_percentile":5426.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrhythmia And Conduction Disorders With Cc","code_information":[{"code":"309","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3310.65,"maximum":3310.65,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3310.65},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":3310.65}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc","code_information":[{"code":"310","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2547.45,"maximum":2547.45,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2547.45},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":2547.45}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Angina Pectoris","code_information":[{"code":"311","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3158.55,"maximum":3158.55,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3158.55},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":3158.55}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Syncope And Collapse","code_information":[{"code":"312","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3922.2,"maximum":3922.2,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3922.2},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":3922.2}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"1 through 10","median_amount":2668.62,"10th_percentile":2668.62,"90th_percentile":2668.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chest Pain","code_information":[{"code":"313","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3240.0,"maximum":3240.0,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3240.0},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":3240.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System Diagnoses With Mcc","code_information":[{"code":"314","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9383.4,"maximum":9383.4,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9383.4},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":9383.4}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System Diagnoses With Cc","code_information":[{"code":"315","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4334.85,"maximum":4334.85,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4334.85},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":4334.85}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System Diagnoses Without Cc/Mcc","code_information":[{"code":"316","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3069.45,"maximum":3069.45,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3069.45},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":3069.45}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concomitant Left Atrial Appendage Closure And Cardiac Ablation","code_information":[{"code":"317","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30089.25,"maximum":30089.25,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30089.25},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":30089.25}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Coronary Atherectomy Without Intraluminal Device","code_information":[{"code":"318","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10899.9,"maximum":10899.9,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10899.9},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":10899.9}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endovascular Cardiac Valve Procedures With Mcc","code_information":[{"code":"319","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20083.05,"maximum":20083.05,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20083.05},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":20083.05}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endovascular Cardiac Valve Procedures Without Mcc","code_information":[{"code":"320","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10823.85,"maximum":10823.85,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10823.85},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":10823.85}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ Arteries/Intraluminal","code_information":[{"code":"321","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12243.6,"maximum":12243.6,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12243.6},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":12243.6}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc","code_information":[{"code":"322","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7933.5,"maximum":7933.5,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7933.5},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7933.5}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"1 through 10","median_amount":6496.64,"10th_percentile":6496.64,"90th_percentile":6496.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"1 through 10","median_amount":29749.78,"10th_percentile":29749.78,"90th_percentile":29749.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc","code_information":[{"code":"323","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19473.3,"maximum":19473.3,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19473.3},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":19473.3}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc","code_information":[{"code":"324","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14179.5,"maximum":14179.5,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14179.5},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":14179.5}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Intravascular Lithotripsy Without Intraluminal Device","code_information":[{"code":"325","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14446.8,"maximum":14446.8,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14446.8},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":14446.8}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal And Duodenal Procedures With Mcc","code_information":[{"code":"326","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22443.3,"maximum":22443.3,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22443.3},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":22443.3}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal And Duodenal Procedures With Cc","code_information":[{"code":"327","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10998.9,"maximum":10998.9,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10998.9},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":10998.9}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal And Duodenal Procedures Without Cc/Mcc","code_information":[{"code":"328","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7210.35,"maximum":7210.35,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7210.35},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7210.35}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Small And Large Bowel Procedures With Mcc","code_information":[{"code":"329","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20684.25,"maximum":20684.25,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20684.25},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":20684.25}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"1 through 10","median_amount":892.13,"10th_percentile":892.13,"90th_percentile":892.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":2507.62,"10th_percentile":2507.62,"90th_percentile":2507.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Small And Large Bowel Procedures With Cc","code_information":[{"code":"330","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10787.4,"maximum":10787.4,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10787.4},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":10787.4}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"1 through 10","median_amount":41016.43,"10th_percentile":41016.43,"90th_percentile":41016.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":21586.76,"10th_percentile":21586.76,"90th_percentile":21586.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Major Small And Large Bowel Procedures Without Cc/Mcc","code_information":[{"code":"331","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7573.05,"maximum":7573.05,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7573.05},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7573.05}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"1 through 10","median_amount":7429.5,"10th_percentile":7429.5,"90th_percentile":7429.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"1 through 10","median_amount":6444.53,"10th_percentile":6444.53,"90th_percentile":6444.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"1 through 10","median_amount":35398.89,"10th_percentile":35398.89,"90th_percentile":35398.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"1 through 10","median_amount":33236.08,"10th_percentile":33236.08,"90th_percentile":33236.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":11197.09,"10th_percentile":11197.09,"90th_percentile":11197.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Rectal Resection With Mcc","code_information":[{"code":"332","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16293.15,"maximum":16293.15,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16293.15},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":16293.15}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rectal Resection With Cc","code_information":[{"code":"333","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10539.9,"maximum":10539.9,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10539.9},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":10539.9}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rectal Resection Without Cc/Mcc","code_information":[{"code":"334","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7370.55,"maximum":7370.55,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7370.55},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7370.55}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peritoneal Adhesiolysis With Mcc","code_information":[{"code":"335","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16069.05,"maximum":16069.05,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16069.05},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":16069.05}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peritoneal Adhesiolysis With Cc","code_information":[{"code":"336","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9489.15,"maximum":9489.15,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9489.15},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":9489.15}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peritoneal Adhesiolysis Without Cc/Mcc","code_information":[{"code":"337","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6907.5,"maximum":6907.5,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6907.5},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6907.5}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Small And Large Bowel Procedures With Mcc","code_information":[{"code":"344","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11622.6,"maximum":11622.6,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11622.6},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":11622.6}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Small And Large Bowel Procedures With Cc","code_information":[{"code":"345","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6771.15,"maximum":6771.15,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6771.15},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6771.15}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Small And Large Bowel Procedures Without Cc/Mcc","code_information":[{"code":"346","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5337.9,"maximum":5337.9,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5337.9},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":5337.9}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Anal And Stomal Procedures With Mcc","code_information":[{"code":"347","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10330.2,"maximum":10330.2,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10330.2},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":10330.2}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Anal And Stomal Procedures With Cc","code_information":[{"code":"348","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5889.6,"maximum":5889.6,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5889.6},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":5889.6}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Anal And Stomal Procedures Without Cc/Mcc","code_information":[{"code":"349","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3917.7,"maximum":3917.7,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3917.7},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":3917.7}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal And Femoral Hernia Procedures With Mcc","code_information":[{"code":"350","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11213.55,"maximum":11213.55,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11213.55},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":11213.55}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal And Femoral Hernia Procedures With Cc","code_information":[{"code":"351","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6860.25,"maximum":6860.25,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6860.25},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6860.25}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal And Femoral Hernia Procedures Without Cc/Mcc","code_information":[{"code":"352","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5255.1,"maximum":5255.1,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5255.1},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":5255.1}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"1 through 10","median_amount":3626.21,"10th_percentile":3626.21,"90th_percentile":3626.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hernia Procedures Except Inguinal And Femoral With Mcc","code_information":[{"code":"353","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13059.0,"maximum":13059.0,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13059.0},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":13059.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hernia Procedures Except Inguinal And Femoral With Cc","code_information":[{"code":"354","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7570.8,"maximum":7570.8,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7570.8},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7570.8}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"1 through 10","median_amount":6454.33,"10th_percentile":6454.33,"90th_percentile":6454.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hernia Procedures Except Inguinal And Femoral Without Cc/Mcc","code_information":[{"code":"355","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6052.5,"maximum":6052.5,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6052.5},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6052.5}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System O.R. Procedures With Mcc","code_information":[{"code":"356","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19767.6,"maximum":19767.6,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19767.6},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":19767.6}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System O.R. Procedures With Cc","code_information":[{"code":"357","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10464.75,"maximum":10464.75,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10464.75},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":10464.75}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System O.R. Procedures Without Cc/Mcc","code_information":[{"code":"358","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6290.55,"maximum":6290.55,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6290.55},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6290.55}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Coronary Atherectomy With Intraluminal Device With Mcc","code_information":[{"code":"359","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15473.7,"maximum":15473.7,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15473.7},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":15473.7}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Coronary Atherectomy With Intraluminal Device Without Mcc","code_information":[{"code":"360","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10864.35,"maximum":10864.35,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10864.35},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":10864.35}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Esophageal Disorders With Mcc","code_information":[{"code":"368","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7163.55,"maximum":7163.55,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7163.55},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7163.55}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Esophageal Disorders With Cc","code_information":[{"code":"369","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4500.9,"maximum":4500.9,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4500.9},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":4500.9}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Esophageal Disorders Without Cc/Mcc","code_information":[{"code":"370","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3153.6,"maximum":3153.6,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3153.6},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":3153.6}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Gastrointestinal Disorders And Peritoneal Infections With Mcc","code_information":[{"code":"371","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7978.95,"maximum":7978.95,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7978.95},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7978.95}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Gastrointestinal Disorders And Peritoneal Infections With Cc","code_information":[{"code":"372","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4594.5,"maximum":4594.5,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4594.5},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":4594.5}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc","code_information":[{"code":"373","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3273.3,"maximum":3273.3,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3273.3},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":3273.3}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Digestive Malignancy With Mcc","code_information":[{"code":"374","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9624.15,"maximum":9624.15,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9624.15},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":9624.15}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Digestive Malignancy With Cc","code_information":[{"code":"375","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5443.2,"maximum":5443.2,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5443.2},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":5443.2}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Digestive Malignancy Without Cc/Mcc","code_information":[{"code":"376","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4159.35,"maximum":4159.35,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4159.35},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":4159.35}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Hemorrhage With Mcc","code_information":[{"code":"377","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8226.0,"maximum":8226.0,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8226.0},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":8226.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Hemorrhage With Cc","code_information":[{"code":"378","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4413.15,"maximum":4413.15,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4413.15},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":4413.15}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"1 through 10","median_amount":3549.36,"10th_percentile":3549.36,"90th_percentile":3549.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"1 through 10","median_amount":2183.25,"10th_percentile":2183.25,"90th_percentile":2183.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Hemorrhage Without Cc/Mcc","code_information":[{"code":"379","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2836.8,"maximum":2836.8,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2836.8},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":2836.8}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"1 through 10","median_amount":301.36,"10th_percentile":301.36,"90th_percentile":301.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"1 through 10","median_amount":6449.32,"10th_percentile":6449.32,"90th_percentile":6449.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"1 through 10","median_amount":7372.43,"10th_percentile":7372.43,"90th_percentile":7372.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"1 through 10","median_amount":25966.58,"10th_percentile":25966.58,"90th_percentile":25966.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complicated Peptic Ulcer With Mcc","code_information":[{"code":"380","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8829.9,"maximum":8829.9,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8829.9},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":8829.9}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complicated Peptic Ulcer With Cc","code_information":[{"code":"381","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4875.75,"maximum":4875.75,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4875.75},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":4875.75}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":22539.48,"10th_percentile":22539.48,"90th_percentile":22539.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complicated Peptic Ulcer Without Cc/Mcc","code_information":[{"code":"382","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3602.7,"maximum":3602.7,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3602.7},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":3602.7}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uncomplicated Peptic Ulcer With Mcc","code_information":[{"code":"383","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6213.15,"maximum":6213.15,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6213.15},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6213.15}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uncomplicated Peptic Ulcer Without Mcc","code_information":[{"code":"384","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3846.6,"maximum":3846.6,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3846.6},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":3846.6}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammatory Bowel Disease With Mcc","code_information":[{"code":"385","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7120.35,"maximum":7120.35,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7120.35},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7120.35}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammatory Bowel Disease With Cc","code_information":[{"code":"386","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4393.35,"maximum":4393.35,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4393.35},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":4393.35}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammatory Bowel Disease Without Cc/Mcc","code_information":[{"code":"387","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3065.85,"maximum":3065.85,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3065.85},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":3065.85}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Obstruction With Mcc","code_information":[{"code":"388","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6645.6,"maximum":6645.6,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6645.6},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6645.6}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Obstruction With Cc","code_information":[{"code":"389","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3554.1,"maximum":3554.1,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3554.1},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":3554.1}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Obstruction Without Cc/Mcc","code_information":[{"code":"390","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2448.0,"maximum":2448.0,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2448.0},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":2448.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"1 through 10","median_amount":1243.14,"10th_percentile":1243.14,"90th_percentile":1243.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc","code_information":[{"code":"391","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5707.35,"maximum":5707.35,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5707.35},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":5707.35}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc","code_information":[{"code":"392","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3508.2,"maximum":3508.2,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3508.2},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":3508.2}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"1 through 10","median_amount":3073.25,"10th_percentile":2984.65,"90th_percentile":4912.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"1 through 10","median_amount":6442.92,"10th_percentile":6442.92,"90th_percentile":6442.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"1 through 10","median_amount":10098.72,"10th_percentile":10098.72,"90th_percentile":10098.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System Diagnoses With Mcc","code_information":[{"code":"393","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7196.85,"maximum":7196.85,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7196.85},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7196.85}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System Diagnoses With Cc","code_information":[{"code":"394","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4210.65,"maximum":4210.65,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4210.65},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":4210.65}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"1 through 10","median_amount":12628.13,"10th_percentile":12628.13,"90th_percentile":12628.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System Diagnoses Without Cc/Mcc","code_information":[{"code":"395","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2920.5,"maximum":2920.5,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2920.5},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":2920.5}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendix Procedures With Mcc","code_information":[{"code":"397","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10777.05,"maximum":10777.05,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10777.05},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":10777.05}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendix Procedures With Cc","code_information":[{"code":"398","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6811.2,"maximum":6811.2,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6811.2},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6811.2}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendix Procedures Without Cc/Mcc","code_information":[{"code":"399","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5151.15,"maximum":5151.15,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5151.15},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":5151.15}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"1 through 10","median_amount":11189.49,"10th_percentile":11189.49,"90th_percentile":11189.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical","code_information":[{"code":"402","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18092.25,"maximum":18092.25,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18092.25},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":18092.25}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pancreas, Liver And Shunt Procedures With Mcc","code_information":[{"code":"405","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24617.25,"maximum":24617.25,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24617.25},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":24617.25}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pancreas, Liver And Shunt Procedures With Cc","code_information":[{"code":"406","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13050.9,"maximum":13050.9,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13050.9},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":13050.9}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pancreas, Liver And Shunt Procedures Without Cc/Mcc","code_information":[{"code":"407","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9988.2,"maximum":9988.2,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9988.2},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":9988.2}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"1 through 10","median_amount":3197.5,"10th_percentile":3197.5,"90th_percentile":3197.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Mcc","code_information":[{"code":"408","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16045.2,"maximum":16045.2,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16045.2},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":16045.2}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc","code_information":[{"code":"409","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9797.85,"maximum":9797.85,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9797.85},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":9797.85}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/Mcc","code_information":[{"code":"410","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7144.65,"maximum":7144.65,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7144.65},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7144.65}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy With C.D.E. With Mcc","code_information":[{"code":"411","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14864.85,"maximum":14864.85,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14864.85},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":14864.85}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy With C.D.E. With Cc","code_information":[{"code":"412","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9461.25,"maximum":9461.25,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9461.25},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":9461.25}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy With C.D.E. Without Cc/Mcc","code_information":[{"code":"413","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7472.25,"maximum":7472.25,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7472.25},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7472.25}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy Except By Laparoscope Without C.D.E. With Mcc","code_information":[{"code":"414","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16031.7,"maximum":16031.7,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16031.7},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":16031.7}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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With Cc","code_information":[{"code":"415","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9300.15,"maximum":9300.15,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9300.15},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":9300.15}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Without Cc/Mcc","code_information":[{"code":"416","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6134.85,"maximum":6134.85,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6134.85},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6134.85}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Laparoscopic Cholecystectomy Without C.D.E. With Mcc","code_information":[{"code":"417","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10738.8,"maximum":10738.8,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10738.8},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":10738.8}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Laparoscopic Cholecystectomy Without C.D.E. With Cc","code_information":[{"code":"418","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7612.2,"maximum":7612.2,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7612.2},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7612.2}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc","code_information":[{"code":"419","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6146.1,"maximum":6146.1,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6146.1},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6146.1}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"1 through 10","median_amount":5929.2,"10th_percentile":5929.2,"90th_percentile":5929.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hepatobiliary Diagnostic Procedures With Mcc","code_information":[{"code":"420","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15331.95,"maximum":15331.95,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15331.95},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":15331.95}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hepatobiliary Diagnostic Procedures With Cc","code_information":[{"code":"421","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7818.75,"maximum":7818.75,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7818.75},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7818.75}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hepatobiliary Diagnostic Procedures Without Cc/Mcc","code_information":[{"code":"422","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6297.75,"maximum":6297.75,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6297.75},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6297.75}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Hepatobiliary Or Pancreas O.R. Procedures With Mcc","code_information":[{"code":"423","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18688.5,"maximum":18688.5,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18688.5},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":18688.5}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Hepatobiliary Or Pancreas O.R. Procedures With Cc","code_information":[{"code":"424","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9845.55,"maximum":9845.55,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9845.55},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":9845.55}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/Mcc","code_information":[{"code":"425","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6751.35,"maximum":6751.35,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6751.35},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6751.35}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Mcc Or Custom-Made","code_information":[{"code":"426","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":49595.4,"maximum":49595.4,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49595.4},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":49595.4}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Cc","code_information":[{"code":"427","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32483.7,"maximum":32483.7,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32483.7},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":32483.7}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Without Cc/Mcc","code_information":[{"code":"428","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25299.0,"maximum":25299.0,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25299.0},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":25299.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Cervical Spinal Fusion With Mcc","code_information":[{"code":"429","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":40543.2,"maximum":40543.2,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40543.2},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":40543.2}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc","code_information":[{"code":"430","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25951.95,"maximum":25951.95,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25951.95},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":25951.95}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cirrhosis And Alcoholic Hepatitis With Mcc","code_information":[{"code":"432","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8856.9,"maximum":8856.9,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8856.9},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":8856.9}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cirrhosis And Alcoholic Hepatitis With Cc","code_information":[{"code":"433","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4752.9,"maximum":4752.9,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4752.9},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":4752.9}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cirrhosis And Alcoholic Hepatitis Without Cc/Mcc","code_information":[{"code":"434","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3206.25,"maximum":3206.25,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3206.25},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":3206.25}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy Of Hepatobiliary System Or Pancreas With Mcc","code_information":[{"code":"435","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8265.15,"maximum":8265.15,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8265.15},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":8265.15}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy Of Hepatobiliary System Or Pancreas With Cc","code_information":[{"code":"436","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5089.95,"maximum":5089.95,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5089.95},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":5089.95}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy Of Hepatobiliary System Or Pancreas Without Cc/Mcc","code_information":[{"code":"437","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3839.85,"maximum":3839.85,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3839.85},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":3839.85}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Pancreas Except Malignancy With Mcc","code_information":[{"code":"438","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7335.9,"maximum":7335.9,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7335.9},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7335.9}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Pancreas Except Malignancy With Cc","code_information":[{"code":"439","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3785.4,"maximum":3785.4,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3785.4},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":3785.4}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Pancreas Except Malignancy Without Cc/Mcc","code_information":[{"code":"440","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2796.3,"maximum":2796.3,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2796.3},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":2796.3}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc","code_information":[{"code":"441","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8076.15,"maximum":8076.15,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8076.15},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":8076.15}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc","code_information":[{"code":"442","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4343.85,"maximum":4343.85,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4343.85},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":4343.85}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/Mcc","code_information":[{"code":"443","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3148.65,"maximum":3148.65,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3148.65},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":3148.65}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of The Biliary Tract With Mcc","code_information":[{"code":"444","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7519.05,"maximum":7519.05,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7519.05},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7519.05}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of The Biliary Tract With Cc","code_information":[{"code":"445","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4924.8,"maximum":4924.8,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4924.8},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":4924.8}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of The Biliary Tract Without Cc/Mcc","code_information":[{"code":"446","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3722.85,"maximum":3722.85,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3722.85},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":3722.85}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody","code_information":[{"code":"447","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30067.2,"maximum":30067.2,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30067.2},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":30067.2}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Spinal Fusion Except Cervical Without Mcc","code_information":[{"code":"448","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19083.6,"maximum":19083.6,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19083.6},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":19083.6}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Single Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody F","code_information":[{"code":"450","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23983.2,"maximum":23983.2,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23983.2},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":23983.2}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Single Level Spinal Fusion Except Cervical Without Mcc","code_information":[{"code":"451","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14536.8,"maximum":14536.8,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14536.8},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":14536.8}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","code_information":[{"code":"456","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":37815.3,"maximum":37815.3,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37815.3},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":37815.3}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","code_information":[{"code":"457","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26833.95,"maximum":26833.95,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26833.95},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":26833.95}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","code_information":[{"code":"458","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18776.7,"maximum":18776.7,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18776.7},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":18776.7}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc","code_information":[{"code":"461","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24853.5,"maximum":24853.5,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24853.5},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":24853.5}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc","code_information":[{"code":"462","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11970.0,"maximum":11970.0,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11970.0},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":11970.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","code_information":[{"code":"463","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25647.75,"maximum":25647.75,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25647.75},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":25647.75}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","code_information":[{"code":"464","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14016.15,"maximum":14016.15,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14016.15},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":14016.15}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":12372.12,"10th_percentile":12372.12,"90th_percentile":12372.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","code_information":[{"code":"465","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8206.65,"maximum":8206.65,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8206.65},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":8206.65}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Revision Of Hip Or Knee Replacement With Mcc","code_information":[{"code":"466","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23424.3,"maximum":23424.3,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23424.3},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":23424.3}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Revision Of Hip Or Knee Replacement With Cc","code_information":[{"code":"467","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15869.7,"maximum":15869.7,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15869.7},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":15869.7}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"1 through 10","median_amount":3215.27,"10th_percentile":3215.27,"90th_percentile":3215.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Revision Of Hip Or Knee Replacement Without Cc/Mcc","code_information":[{"code":"468","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12366.0,"maximum":12366.0,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12366.0},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":12366.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"1 through 10","median_amount":11804.85,"10th_percentile":11804.85,"90th_percentile":11804.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc Or Total Ankle Repl","code_information":[{"code":"469","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13649.4,"maximum":13649.4,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13649.4},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":13649.4}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc","code_information":[{"code":"470","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8680.05,"maximum":8680.05,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8680.05},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":8680.05}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"1 through 10","median_amount":3219.76,"10th_percentile":3219.76,"90th_percentile":3219.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cervical Spinal Fusion With Mcc","code_information":[{"code":"471","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21729.15,"maximum":21729.15,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21729.15},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":21729.15}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cervical Spinal Fusion With Cc","code_information":[{"code":"472","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13257.45,"maximum":13257.45,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13257.45},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":13257.45}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cervical Spinal Fusion Without Cc/Mcc","code_information":[{"code":"473","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10985.85,"maximum":10985.85,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10985.85},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":10985.85}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc","code_information":[{"code":"474","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19318.05,"maximum":19318.05,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19318.05},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":19318.05}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc","code_information":[{"code":"475","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10240.65,"maximum":10240.65,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10240.65},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":10240.65}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/Mcc","code_information":[{"code":"476","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5310.9,"maximum":5310.9,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5310.9},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":5310.9}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biopsies Of Musculoskeletal System And Connective Tissue With Mcc","code_information":[{"code":"477","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15545.7,"maximum":15545.7,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15545.7},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":15545.7}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biopsies Of Musculoskeletal System And Connective Tissue With Cc","code_information":[{"code":"478","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11066.4,"maximum":11066.4,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11066.4},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":11066.4}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/Mcc","code_information":[{"code":"479","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8365.05,"maximum":8365.05,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8365.05},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":8365.05}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip And Femur Procedures Except Major Joint With Mcc","code_information":[{"code":"480","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13105.35,"maximum":13105.35,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13105.35},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":13105.35}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip And Femur Procedures Except Major Joint With Cc","code_information":[{"code":"481","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9425.25,"maximum":9425.25,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9425.25},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":9425.25}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":3248.78,"10th_percentile":3248.78,"90th_percentile":3248.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"1 through 10","median_amount":6693.0,"10th_percentile":6693.0,"90th_percentile":6693.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"1 through 10","median_amount":6446.32,"10th_percentile":6446.32,"90th_percentile":6446.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"1 through 10","median_amount":3314.93,"10th_percentile":3314.93,"90th_percentile":3314.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"1 through 10","median_amount":6439.52,"10th_percentile":6439.52,"90th_percentile":6439.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip And Femur Procedures Except Major Joint Without Cc/Mcc","code_information":[{"code":"482","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7339.5,"maximum":7339.5,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7339.5},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7339.5}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Joint Or Limb Reattachment Procedures Of Upper Extremities","code_information":[{"code":"483","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12473.55,"maximum":12473.55,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12473.55},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":12473.55}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"1 through 10","median_amount":3319.68,"10th_percentile":3319.68,"90th_percentile":3319.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures With Principal Diagnosis Of Infection With Mcc","code_information":[{"code":"485","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14521.95,"maximum":14521.95,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14521.95},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":14521.95}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures With Principal Diagnosis Of Infection With Cc","code_information":[{"code":"486","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9409.95,"maximum":9409.95,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9409.95},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":9409.95}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"1 through 10","median_amount":9544.05,"10th_percentile":9544.05,"90th_percentile":9544.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures With Principal Diagnosis Of Infection Without Cc/Mcc","code_information":[{"code":"487","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7047.9,"maximum":7047.9,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7047.9},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7047.9}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures Without Principal Diagnosis Of Infection With Cc/Mcc","code_information":[{"code":"488","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7960.05,"maximum":7960.05,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7960.05},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7960.05}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures Without Principal Diagnosis Of Infection Without Cc/Mcc","code_information":[{"code":"489","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5025.6,"maximum":5025.6,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5025.6},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":5025.6}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc","code_information":[{"code":"492","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16522.2,"maximum":16522.2,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16522.2},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":16522.2}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc","code_information":[{"code":"493","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11412.45,"maximum":11412.45,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11412.45},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":11412.45}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"1 through 10","median_amount":23336.13,"10th_percentile":23336.13,"90th_percentile":23336.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc","code_information":[{"code":"494","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9029.25,"maximum":9029.25,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9029.25},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":9029.25}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"1 through 10","median_amount":395.0,"10th_percentile":395.0,"90th_percentile":395.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Mcc","code_information":[{"code":"495","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16315.65,"maximum":16315.65,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16315.65},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":16315.65}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc","code_information":[{"code":"496","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8117.55,"maximum":8117.55,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8117.55},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":8117.55}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/Mcc","code_information":[{"code":"497","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5437.35,"maximum":5437.35,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5437.35},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":5437.35}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/Mcc","code_information":[{"code":"498","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13575.6,"maximum":13575.6,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13575.6},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":13575.6}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/Mcc","code_information":[{"code":"499","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9066.6,"maximum":9066.6,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9066.6},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":9066.6}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Soft Tissue Procedures With Mcc","code_information":[{"code":"500","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14241.6,"maximum":14241.6,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14241.6},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":14241.6}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Soft Tissue Procedures With Cc","code_information":[{"code":"501","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7866.45,"maximum":7866.45,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7866.45},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7866.45}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Soft Tissue Procedures Without Cc/Mcc","code_information":[{"code":"502","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6056.55,"maximum":6056.55,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6056.55},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6056.55}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Foot Procedures With Mcc","code_information":[{"code":"503","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12559.95,"maximum":12559.95,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12559.95},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":12559.95}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Foot Procedures With Cc","code_information":[{"code":"504","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8411.4,"maximum":8411.4,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8411.4},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":8411.4}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Foot Procedures Without Cc/Mcc","code_information":[{"code":"505","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8067.6,"maximum":8067.6,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8067.6},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":8067.6}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Thumb Or Joint Procedures","code_information":[{"code":"506","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6071.4,"maximum":6071.4,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6071.4},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6071.4}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Shoulder Or Elbow Joint Procedures With Cc/Mcc","code_information":[{"code":"507","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8128.8,"maximum":8128.8,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8128.8},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":8128.8}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Shoulder Or Elbow Joint Procedures Without Cc/Mcc","code_information":[{"code":"508","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6814.8,"maximum":6814.8,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6814.8},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6814.8}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc","code_information":[{"code":"510","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13592.25,"maximum":13592.25,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13592.25},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":13592.25}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc","code_information":[{"code":"511","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9357.3,"maximum":9357.3,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9357.3},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":9357.3}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/Mcc","code_information":[{"code":"512","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7449.3,"maximum":7449.3,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7449.3},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7449.3}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/Mcc","code_information":[{"code":"513","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7084.35,"maximum":7084.35,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7084.35},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7084.35}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/Mcc","code_information":[{"code":"514","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4600.35,"maximum":4600.35,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4600.35},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":4600.35}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Mcc","code_information":[{"code":"515","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14341.05,"maximum":14341.05,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14341.05},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":14341.05}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc","code_information":[{"code":"516","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9351.45,"maximum":9351.45,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9351.45},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":9351.45}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/Mcc","code_information":[{"code":"517","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6915.15,"maximum":6915.15,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6915.15},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6915.15}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"1 through 10","median_amount":6693.0,"10th_percentile":6693.0,"90th_percentile":6693.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurostimulator","code_information":[{"code":"518","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16817.85,"maximum":16817.85,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16817.85},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":16817.85}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back And Neck Procedures Except Spinal Fusion With Cc","code_information":[{"code":"519","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9000.9,"maximum":9000.9,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9000.9},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":9000.9}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back And Neck Procedures Except Spinal Fusion Without Cc/Mcc","code_information":[{"code":"520","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6722.55,"maximum":6722.55,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6722.55},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6722.55}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc","code_information":[{"code":"521","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12915.9,"maximum":12915.9,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12915.9},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":12915.9}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"1 through 10","median_amount":51754.29,"10th_percentile":51754.29,"90th_percentile":51754.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc","code_information":[{"code":"522","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9529.65,"maximum":9529.65,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9529.65},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":9529.65}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"1 through 10","median_amount":1615.9,"10th_percentile":1615.9,"90th_percentile":1615.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"1 through 10","median_amount":12782.79,"10th_percentile":9665.29,"90th_percentile":12887.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fractures Of Femur With Mcc","code_information":[{"code":"533","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7054.65,"maximum":7054.65,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7054.65},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7054.65}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fractures Of Femur Without Mcc","code_information":[{"code":"534","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3627.45,"maximum":3627.45,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3627.45},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":3627.45}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fractures Of Hip And Pelvis With Mcc","code_information":[{"code":"535","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5769.0,"maximum":5769.0,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5769.0},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":5769.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fractures Of Hip And Pelvis Without Mcc","code_information":[{"code":"536","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3634.2,"maximum":3634.2,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3634.2},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":3634.2}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"1 through 10","median_amount":7711.91,"10th_percentile":7711.91,"90th_percentile":7711.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/Mcc","code_information":[{"code":"537","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4294.35,"maximum":4294.35,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4294.35},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":4294.35}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/Mcc","code_information":[{"code":"538","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3241.35,"maximum":3241.35,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3241.35},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":3241.35}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Osteomyelitis With Mcc","code_information":[{"code":"539","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8863.65,"maximum":8863.65,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8863.65},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":8863.65}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Osteomyelitis With Cc","code_information":[{"code":"540","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5833.35,"maximum":5833.35,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5833.35},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":5833.35}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Osteomyelitis Without Cc/Mcc","code_information":[{"code":"541","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3543.3,"maximum":3543.3,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3543.3},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":3543.3}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Mcc","code_information":[{"code":"542","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7949.25,"maximum":7949.25,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7949.25},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7949.25}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc","code_information":[{"code":"543","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4626.0,"maximum":4626.0,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4626.0},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":4626.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/Mcc","code_information":[{"code":"544","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3395.7,"maximum":3395.7,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3395.7},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":3395.7}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Connective Tissue Disorders With Mcc","code_information":[{"code":"545","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11167.65,"maximum":11167.65,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11167.65},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":11167.65}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Connective Tissue Disorders With Cc","code_information":[{"code":"546","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5190.3,"maximum":5190.3,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5190.3},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":5190.3}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Connective Tissue Disorders Without Cc/Mcc","code_information":[{"code":"547","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3762.9,"maximum":3762.9,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3762.9},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":3762.9}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septic Arthritis With Mcc","code_information":[{"code":"548","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8689.05,"maximum":8689.05,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8689.05},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":8689.05}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septic Arthritis With Cc","code_information":[{"code":"549","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5432.4,"maximum":5432.4,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5432.4},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":5432.4}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septic Arthritis Without Cc/Mcc","code_information":[{"code":"550","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3933.45,"maximum":3933.45,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3933.45},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":3933.45}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Medical Back Problems With Mcc","code_information":[{"code":"551","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7542.45,"maximum":7542.45,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7542.45},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7542.45}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Medical Back Problems Without Mcc","code_information":[{"code":"552","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4325.85,"maximum":4325.85,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4325.85},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":4325.85}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bone Diseases And Arthropathies With Mcc","code_information":[{"code":"553","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5833.35,"maximum":5833.35,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5833.35},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":5833.35}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bone Diseases And Arthropathies Without Mcc","code_information":[{"code":"554","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3735.45,"maximum":3735.45,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3735.45},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":3735.45}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Signs And Symptoms Of Musculoskeletal System And Connective Tissue With Mcc","code_information":[{"code":"555","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5948.1,"maximum":5948.1,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5948.1},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":5948.1}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc","code_information":[{"code":"556","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3737.7,"maximum":3737.7,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3737.7},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":3737.7}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tendonitis, Myositis And Bursitis With Mcc","code_information":[{"code":"557","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6691.05,"maximum":6691.05,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6691.05},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6691.05}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"1 through 10","median_amount":6384.0,"10th_percentile":6384.0,"90th_percentile":6384.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"1 through 10","median_amount":6436.52,"10th_percentile":6436.52,"90th_percentile":6436.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tendonitis, Myositis And Bursitis Without Mcc","code_information":[{"code":"558","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4019.4,"maximum":4019.4,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4019.4},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":4019.4}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"1 through 10","median_amount":6210.43,"10th_percentile":6210.43,"90th_percentile":6210.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare, Musculoskeletal System And Connective Tissue With Mcc","code_information":[{"code":"559","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8392.05,"maximum":8392.05,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8392.05},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":8392.05}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"1 through 10","median_amount":16425.92,"10th_percentile":16425.92,"90th_percentile":16425.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare, Musculoskeletal System And Connective Tissue With Cc","code_information":[{"code":"560","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5067.45,"maximum":5067.45,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5067.45},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":5067.45}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc","code_information":[{"code":"561","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3617.55,"maximum":3617.55,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3617.55},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":3617.55}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"1 through 10","median_amount":13386.0,"10th_percentile":13386.0,"90th_percentile":13386.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With Mcc","code_information":[{"code":"562","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6411.6,"maximum":6411.6,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6411.6},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6411.6}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without Mcc","code_information":[{"code":"563","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4029.75,"maximum":4029.75,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4029.75},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":4029.75}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue Diagnoses With Mcc","code_information":[{"code":"564","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6946.2,"maximum":6946.2,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6946.2},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6946.2}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":12894.57,"10th_percentile":12894.57,"90th_percentile":12894.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue Diagnoses With Cc","code_information":[{"code":"565","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4384.8,"maximum":4384.8,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4384.8},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":4384.8}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/Mcc","code_information":[{"code":"566","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3371.85,"maximum":3371.85,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3371.85},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":3371.85}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Debridement With Mcc","code_information":[{"code":"570","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13234.95,"maximum":13234.95,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13234.95},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":13234.95}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Debridement With Cc","code_information":[{"code":"571","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7602.75,"maximum":7602.75,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7602.75},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7602.75}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Debridement Without Cc/Mcc","code_information":[{"code":"572","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5158.35,"maximum":5158.35,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5158.35},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":5158.35}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft For Skin Ulcer Or Cellulitis With Mcc","code_information":[{"code":"573","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29481.3,"maximum":29481.3,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29481.3},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":29481.3}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft For Skin Ulcer Or Cellulitis With Cc","code_information":[{"code":"574","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15621.3,"maximum":15621.3,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15621.3},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":15621.3}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft For Skin Ulcer Or Cellulitis Without Cc/Mcc","code_information":[{"code":"575","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8086.5,"maximum":8086.5,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8086.5},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":8086.5}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc","code_information":[{"code":"576","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22055.4,"maximum":22055.4,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22055.4},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":22055.4}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft Except For Skin Ulcer Or Cellulitis With Cc","code_information":[{"code":"577","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11928.15,"maximum":11928.15,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11928.15},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":11928.15}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/Mcc","code_information":[{"code":"578","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7228.8,"maximum":7228.8,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7228.8},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7228.8}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc","code_information":[{"code":"579","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14573.25,"maximum":14573.25,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14573.25},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":14573.25}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Skin, Subcutaneous Tissue And Breast Procedures With Cc","code_information":[{"code":"580","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7776.0,"maximum":7776.0,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7776.0},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7776.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/Mcc","code_information":[{"code":"581","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6493.95,"maximum":6493.95,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6493.95},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6493.95}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mastectomy For Malignancy With Cc/Mcc","code_information":[{"code":"582","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8669.7,"maximum":8669.7,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8669.7},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":8669.7}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mastectomy For Malignancy Without Cc/Mcc","code_information":[{"code":"583","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7759.8,"maximum":7759.8,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7759.8},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7759.8}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Breast Biopsy, Local Excision And Other Breast Procedures With Cc/Mcc","code_information":[{"code":"584","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9633.15,"maximum":9633.15,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9633.15},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":9633.15}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/Mcc","code_information":[{"code":"585","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8680.95,"maximum":8680.95,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8680.95},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":8680.95}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Ulcers With Mcc","code_information":[{"code":"592","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8708.85,"maximum":8708.85,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8708.85},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":8708.85}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Ulcers With Cc","code_information":[{"code":"593","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5338.35,"maximum":5338.35,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5338.35},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":5338.35}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Ulcers Without Cc/Mcc","code_information":[{"code":"594","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3900.6,"maximum":3900.6,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3900.6},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":3900.6}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Skin Disorders With Mcc","code_information":[{"code":"595","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9543.15,"maximum":9543.15,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9543.15},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":9543.15}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Skin Disorders Without Mcc","code_information":[{"code":"596","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4871.25,"maximum":4871.25,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4871.25},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":4871.25}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignant Breast Disorders With Mcc","code_information":[{"code":"597","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7501.95,"maximum":7501.95,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7501.95},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7501.95}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignant Breast Disorders With Cc","code_information":[{"code":"598","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5090.85,"maximum":5090.85,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5090.85},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":5090.85}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignant Breast Disorders Without Cc/Mcc","code_information":[{"code":"599","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3462.3,"maximum":3462.3,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3462.3},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":3462.3}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Malignant Breast Disorders With Cc/Mcc","code_information":[{"code":"600","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4687.2,"maximum":4687.2,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4687.2},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":4687.2}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Malignant Breast Disorders Without Cc/Mcc","code_information":[{"code":"601","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2722.5,"maximum":2722.5,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2722.5},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":2722.5}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cellulitis With Mcc","code_information":[{"code":"602","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6395.85,"maximum":6395.85,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6395.85},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6395.85}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cellulitis Without Mcc","code_information":[{"code":"603","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3919.05,"maximum":3919.05,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3919.05},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":3919.05}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"1 through 10","median_amount":13099.5,"10th_percentile":13099.5,"90th_percentile":13099.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"1 through 10","median_amount":12884.65,"10th_percentile":12884.65,"90th_percentile":12884.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Trauma To The Skin, Subcutaneous Tissue And Breast With Mcc","code_information":[{"code":"604","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6624.45,"maximum":6624.45,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6624.45},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6624.45}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc","code_information":[{"code":"605","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4122.0,"maximum":4122.0,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4122.0},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":4122.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Skin Disorders With Mcc","code_information":[{"code":"606","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6809.4,"maximum":6809.4,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6809.4},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6809.4}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Skin Disorders Without Mcc","code_information":[{"code":"607","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4078.8,"maximum":4078.8,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4078.8},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":4078.8}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Adrenal And Pituitary Procedures With Cc/Mcc","code_information":[{"code":"614","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9863.1,"maximum":9863.1,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9863.1},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":9863.1}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Adrenal And Pituitary Procedures Without Cc/Mcc","code_information":[{"code":"615","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6296.85,"maximum":6296.85,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6296.85},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6296.85}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Mcc","code_information":[{"code":"616","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15693.3,"maximum":15693.3,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15693.3},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":15693.3}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc","code_information":[{"code":"617","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8416.35,"maximum":8416.35,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8416.35},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":8416.35}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc","code_information":[{"code":"618","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6382.35,"maximum":6382.35,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6382.35},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6382.35}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. 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Procedures For Obesity With Mcc","code_information":[{"code":"619","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12993.3,"maximum":12993.3,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12993.3},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":12993.3}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Procedures For Obesity With Cc","code_information":[{"code":"620","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7201.35,"maximum":7201.35,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7201.35},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7201.35}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures For Obesity Without Cc/Mcc","code_information":[{"code":"621","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6787.8,"maximum":6787.8,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6787.8},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6787.8}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"1 through 10","median_amount":12040.78,"10th_percentile":12040.78,"90th_percentile":12040.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Mcc","code_information":[{"code":"622","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16016.4,"maximum":16016.4,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16016.4},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":16016.4}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc","code_information":[{"code":"623","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8072.55,"maximum":8072.55,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8072.55},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":8072.55}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc","code_information":[{"code":"624","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5633.55,"maximum":5633.55,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5633.55},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":5633.55}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Thyroid, Parathyroid And Thyroglossal Procedures With Mcc","code_information":[{"code":"625","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13590.45,"maximum":13590.45,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13590.45},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":13590.45}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Thyroid, Parathyroid And Thyroglossal Procedures With Cc","code_information":[{"code":"626","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6747.3,"maximum":6747.3,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6747.3},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6747.3}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/Mcc","code_information":[{"code":"627","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5977.35,"maximum":5977.35,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5977.35},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":5977.35}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Mcc","code_information":[{"code":"628","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16770.6,"maximum":16770.6,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16770.6},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":16770.6}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc","code_information":[{"code":"629","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9804.6,"maximum":9804.6,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9804.6},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":9804.6}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"1 through 10","median_amount":4127.4,"10th_percentile":4127.4,"90th_percentile":4127.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endocrine, Nutritional And Metabolic O.R. Procedures Without Cc/Mcc","code_information":[{"code":"630","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6567.75,"maximum":6567.75,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6567.75},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6567.75}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Diabetes With Mcc","code_information":[{"code":"637","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6465.15,"maximum":6465.15,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6465.15},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6465.15}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Diabetes With Cc","code_information":[{"code":"638","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4032.9,"maximum":4032.9,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4032.9},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":4032.9}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"1 through 10","median_amount":2734.97,"10th_percentile":2734.97,"90th_percentile":2734.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Diabetes Without Cc/Mcc","code_information":[{"code":"639","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2795.4,"maximum":2795.4,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2795.4},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":2795.4}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc","code_information":[{"code":"640","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6010.2,"maximum":6010.2,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6010.2},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6010.2}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc","code_information":[{"code":"641","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3501.9,"maximum":3501.9,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3501.9},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":3501.9}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inborn And Other Disorders Of Metabolism","code_information":[{"code":"642","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6399.45,"maximum":6399.45,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6399.45},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6399.45}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endocrine Disorders With Mcc","code_information":[{"code":"643","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7407.45,"maximum":7407.45,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7407.45},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7407.45}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endocrine Disorders With Cc","code_information":[{"code":"644","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4612.5,"maximum":4612.5,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4612.5},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":4612.5}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endocrine Disorders Without Cc/Mcc","code_information":[{"code":"645","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3457.35,"maximum":3457.35,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3457.35},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":3457.35}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney Transplant With Hemodialysis With Mcc","code_information":[{"code":"650","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21156.3,"maximum":21156.3,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21156.3},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":21156.3}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney Transplant With Hemodialysis Without Mcc","code_information":[{"code":"651","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16676.1,"maximum":16676.1,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16676.1},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":16676.1}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney Transplant","code_information":[{"code":"652","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14532.75,"maximum":14532.75,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14532.75},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":14532.75}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Bladder Procedures With Mcc","code_information":[{"code":"653","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23383.8,"maximum":23383.8,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23383.8},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":23383.8}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Bladder Procedures With Cc","code_information":[{"code":"654","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12596.85,"maximum":12596.85,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12596.85},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":12596.85}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Bladder Procedures Without Cc/Mcc","code_information":[{"code":"655","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9524.7,"maximum":9524.7,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9524.7},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":9524.7}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Neoplasm With Mcc","code_information":[{"code":"656","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14327.1,"maximum":14327.1,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14327.1},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":14327.1}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Neoplasm With Cc","code_information":[{"code":"657","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8235.0,"maximum":8235.0,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8235.0},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":8235.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Neoplasm Without Cc/Mcc","code_information":[{"code":"658","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6983.1,"maximum":6983.1,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6983.1},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6983.1}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Non-Neoplasm With Mcc","code_information":[{"code":"659","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11434.05,"maximum":11434.05,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11434.05},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":11434.05}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"1 through 10","median_amount":28737.98,"10th_percentile":28737.98,"90th_percentile":28737.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Non-Neoplasm With Cc","code_information":[{"code":"660","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5947.65,"maximum":5947.65,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5947.65},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":5947.65}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Non-Neoplasm Without Cc/Mcc","code_information":[{"code":"661","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4659.3,"maximum":4659.3,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4659.3},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":4659.3}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":6430.52,"10th_percentile":6430.52,"90th_percentile":6430.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"1 through 10","median_amount":4619.7,"10th_percentile":4619.7,"90th_percentile":4619.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Bladder Procedures With Mcc","code_information":[{"code":"662","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13776.75,"maximum":13776.75,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13776.75},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":13776.75}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Bladder Procedures With Cc","code_information":[{"code":"663","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6840.9,"maximum":6840.9,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6840.9},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6840.9}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Bladder Procedures Without Cc/Mcc","code_information":[{"code":"664","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4711.05,"maximum":4711.05,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4711.05},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":4711.05}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatectomy With Mcc","code_information":[{"code":"665","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14045.4,"maximum":14045.4,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14045.4},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":14045.4}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatectomy With Cc","code_information":[{"code":"666","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7871.85,"maximum":7871.85,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7871.85},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7871.85}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatectomy Without Cc/Mcc","code_information":[{"code":"667","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4977.9,"maximum":4977.9,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4977.9},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":4977.9}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Procedures With Mcc","code_information":[{"code":"668","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13140.0,"maximum":13140.0,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13140.0},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":13140.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Procedures With Cc","code_information":[{"code":"669","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6984.0,"maximum":6984.0,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6984.0},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6984.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Procedures Without Cc/Mcc","code_information":[{"code":"670","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4397.85,"maximum":4397.85,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4397.85},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":4397.85}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urethral Procedures With Cc/Mcc","code_information":[{"code":"671","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8077.5,"maximum":8077.5,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8077.5},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":8077.5}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urethral Procedures Without Cc/Mcc","code_information":[{"code":"672","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4857.75,"maximum":4857.75,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4857.75},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":4857.75}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Procedures With Mcc","code_information":[{"code":"673","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18907.2,"maximum":18907.2,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18907.2},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":18907.2}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Procedures With Cc","code_information":[{"code":"674","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10523.7,"maximum":10523.7,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10523.7},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":10523.7}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Procedures Without Cc/Mcc","code_information":[{"code":"675","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7386.3,"maximum":7386.3,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7386.3},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7386.3}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Renal Failure With Mcc","code_information":[{"code":"682","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6664.5,"maximum":6664.5,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6664.5},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6664.5}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Renal Failure With Cc","code_information":[{"code":"683","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3941.1,"maximum":3941.1,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3941.1},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":3941.1}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"1 through 10","median_amount":2116.06,"10th_percentile":2116.06,"90th_percentile":2116.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Renal Failure Without Cc/Mcc","code_information":[{"code":"684","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2701.35,"maximum":2701.35,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2701.35},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":2701.35}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Neoplasms With Mcc","code_information":[{"code":"686","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8116.65,"maximum":8116.65,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8116.65},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":8116.65}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Neoplasms With Cc","code_information":[{"code":"687","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4715.1,"maximum":4715.1,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4715.1},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":4715.1}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Neoplasms Without Cc/Mcc","code_information":[{"code":"688","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3556.35,"maximum":3556.35,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3556.35},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":3556.35}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Infections With Mcc","code_information":[{"code":"689","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5221.35,"maximum":5221.35,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5221.35},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":5221.35}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"1 through 10","median_amount":9659.97,"10th_percentile":9659.97,"90th_percentile":9659.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Infections Without Mcc","code_information":[{"code":"690","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3642.75,"maximum":3642.75,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3642.75},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":3642.75}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":6464.04,"10th_percentile":6464.04,"90th_percentile":6464.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"1 through 10","median_amount":3736.75,"10th_percentile":3736.75,"90th_percentile":3736.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"1 through 10","median_amount":9654.79,"10th_percentile":9654.79,"90th_percentile":9654.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"1 through 10","median_amount":13437.13,"10th_percentile":13437.13,"90th_percentile":13437.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urinary Stones With Mcc","code_information":[{"code":"693","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6050.25,"maximum":6050.25,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6050.25},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6050.25}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urinary Stones Without Mcc","code_information":[{"code":"694","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3517.65,"maximum":3517.65,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3517.65},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":3517.65}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Signs And Symptoms With Mcc","code_information":[{"code":"695","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5147.1,"maximum":5147.1,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5147.1},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":5147.1}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Signs And Symptoms Without Mcc","code_information":[{"code":"696","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3100.5,"maximum":3100.5,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3100.5},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":3100.5}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urethral Stricture","code_information":[{"code":"697","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4850.1,"maximum":4850.1,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4850.1},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":4850.1}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Diagnoses With Mcc","code_information":[{"code":"698","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7444.8,"maximum":7444.8,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7444.8},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7444.8}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Diagnoses With Cc","code_information":[{"code":"699","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4567.5,"maximum":4567.5,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4567.5},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":4567.5}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Diagnoses Without Cc/Mcc","code_information":[{"code":"700","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3104.55,"maximum":3104.55,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3104.55},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":3104.55}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Male Pelvic Procedures With Cc/Mcc","code_information":[{"code":"707","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9001.35,"maximum":9001.35,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9001.35},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":9001.35}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"1 through 10","median_amount":3222.46,"10th_percentile":3222.46,"90th_percentile":3222.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Male Pelvic Procedures Without Cc/Mcc","code_information":[{"code":"708","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6903.9,"maximum":6903.9,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6903.9},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6903.9}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"1 through 10","median_amount":3346.5,"10th_percentile":3346.5,"90th_percentile":3346.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"1 through 10","median_amount":1681.42,"10th_percentile":1681.42,"90th_percentile":1681.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"1 through 10","median_amount":25936.7,"10th_percentile":25936.7,"90th_percentile":25936.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Penis Procedures With Cc/Mcc","code_information":[{"code":"709","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10471.95,"maximum":10471.95,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10471.95},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":10471.95}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Penis Procedures Without Cc/Mcc","code_information":[{"code":"710","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6305.4,"maximum":6305.4,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6305.4},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6305.4}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Testes Procedures With Cc/Mcc","code_information":[{"code":"711","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9377.1,"maximum":9377.1,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9377.1},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":9377.1}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Testes Procedures Without Cc/Mcc","code_information":[{"code":"712","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4948.65,"maximum":4948.65,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4948.65},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":4948.65}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Prostatectomy With Cc/Mcc","code_information":[{"code":"713","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6765.3,"maximum":6765.3,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6765.3},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6765.3}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Prostatectomy Without Cc/Mcc","code_information":[{"code":"714","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4758.3,"maximum":4758.3,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4758.3},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":4758.3}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Procedures For Malignancy With Cc/Mcc","code_information":[{"code":"715","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10067.85,"maximum":10067.85,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10067.85},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":10067.85}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Male Reproductive System With Mcc","code_information":[{"code":"722","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8143.65,"maximum":8143.65,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8143.65},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":8143.65}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Male Reproductive System With Cc","code_information":[{"code":"723","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5142.15,"maximum":5142.15,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5142.15},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":5142.15}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Male Reproductive System Without Cc/Mcc","code_information":[{"code":"724","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2950.65,"maximum":2950.65,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2950.65},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":2950.65}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Benign Prostatic Hypertrophy With Mcc","code_information":[{"code":"725","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5265.9,"maximum":5265.9,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5265.9},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":5265.9}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Benign Prostatic Hypertrophy Without Mcc","code_information":[{"code":"726","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3249.0,"maximum":3249.0,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3249.0},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":3249.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammation Of The Male Reproductive System With Mcc","code_information":[{"code":"727","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6673.05,"maximum":6673.05,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6673.05},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6673.05}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammation Of The Male Reproductive System Without Mcc","code_information":[{"code":"728","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3650.4,"maximum":3650.4,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3650.4},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":3650.4}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System Diagnoses With Cc/Mcc","code_information":[{"code":"729","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4764.15,"maximum":4764.15,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4764.15},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":4764.15}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System Diagnoses Without Cc/Mcc","code_information":[{"code":"730","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3024.0,"maximum":3024.0,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3024.0},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":3024.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/Mcc","code_information":[{"code":"734","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9585.0,"maximum":9585.0,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9585.0},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":9585.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/Mcc","code_information":[{"code":"735","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6054.75,"maximum":6054.75,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6054.75},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6054.75}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc","code_information":[{"code":"736","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16085.25,"maximum":16085.25,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16085.25},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":16085.25}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc","code_information":[{"code":"737","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9272.7,"maximum":9272.7,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9272.7},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":9272.7}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/Mcc","code_information":[{"code":"738","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6608.25,"maximum":6608.25,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6608.25},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6608.25}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Mcc","code_information":[{"code":"739","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16122.6,"maximum":16122.6,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16122.6},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":16122.6}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc","code_information":[{"code":"740","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8143.2,"maximum":8143.2,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8143.2},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":8143.2}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/Mcc","code_information":[{"code":"741","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6417.45,"maximum":6417.45,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6417.45},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6417.45}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc","code_information":[{"code":"742","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8256.6,"maximum":8256.6,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8256.6},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":8256.6}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc","code_information":[{"code":"743","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5583.15,"maximum":5583.15,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5583.15},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":5583.15}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"D&C, Conization, Laparoscopy And Tubal Interruption With Cc/Mcc","code_information":[{"code":"744","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9220.95,"maximum":9220.95,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9220.95},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":9220.95}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/Mcc","code_information":[{"code":"745","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5118.75,"maximum":5118.75,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5118.75},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":5118.75}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vagina, Cervix And Vulva Procedures With Cc/Mcc","code_information":[{"code":"746","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7816.95,"maximum":7816.95,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7816.95},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7816.95}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vagina, Cervix And Vulva Procedures Without Cc/Mcc","code_information":[{"code":"747","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3868.65,"maximum":3868.65,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3868.65},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":3868.65}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Female Reproductive System Reconstructive Procedures","code_information":[{"code":"748","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6242.85,"maximum":6242.85,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6242.85},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6242.85}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Procedures With Cc/Mcc","code_information":[{"code":"749","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11554.2,"maximum":11554.2,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11554.2},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":11554.2}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Female Reproductive System O.R. Procedures Without Cc/Mcc","code_information":[{"code":"750","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6641.1,"maximum":6641.1,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6641.1},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6641.1}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Female Reproductive System With Mcc","code_information":[{"code":"754","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8287.65,"maximum":8287.65,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8287.65},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":8287.65}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Female Reproductive System With Cc","code_information":[{"code":"755","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4895.1,"maximum":4895.1,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4895.1},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":4895.1}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Female Reproductive System Without Cc/Mcc","code_information":[{"code":"756","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4322.25,"maximum":4322.25,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4322.25},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":4322.25}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infections, Female Reproductive System With Mcc","code_information":[{"code":"757","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6443.55,"maximum":6443.55,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6443.55},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6443.55}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infections, Female Reproductive System With Cc","code_information":[{"code":"758","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4405.5,"maximum":4405.5,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4405.5},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":4405.5}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infections, Female Reproductive System Without Cc/Mcc","code_information":[{"code":"759","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2986.2,"maximum":2986.2,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2986.2},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":2986.2}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Menstrual And Other Female Reproductive System Disorders With Cc/Mcc","code_information":[{"code":"760","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4533.75,"maximum":4533.75,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4533.75},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":4533.75}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Menstrual And Other Female Reproductive System Disorders Without Cc/Mcc","code_information":[{"code":"761","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2567.25,"maximum":2567.25,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2567.25},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":2567.25}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C","code_information":[{"code":"768","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4822.2,"maximum":4822.2,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4822.2},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":4822.2}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"1 through 10","median_amount":4596.59,"10th_percentile":4596.59,"90th_percentile":4596.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postpartum And Post Abortion Diagnoses With O.R. Procedures","code_information":[{"code":"769","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7604.1,"maximum":7604.1,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7604.1},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7604.1}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Abortion With D&C, Aspiration Curettage Or Hysterotomy","code_information":[{"code":"770","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4512.15,"maximum":4512.15,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4512.15},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":4512.15}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postpartum And Post Abortion Diagnoses Without O.R. Procedures","code_information":[{"code":"776","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2946.15,"maximum":2946.15,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2946.15},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":2946.15}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"1 through 10","median_amount":2835.28,"10th_percentile":2835.28,"90th_percentile":2835.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"1 through 10","median_amount":2977.04,"10th_percentile":2977.04,"90th_percentile":2977.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Abortion Without D&C","code_information":[{"code":"779","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3785.85,"maximum":3785.85,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3785.85},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":3785.85}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section With Sterilization With Mcc","code_information":[{"code":"783","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11047.95,"maximum":11047.95,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11047.95},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":11047.95}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":6843.7,"10th_percentile":6843.7,"90th_percentile":6843.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section With Sterilization With Cc","code_information":[{"code":"784","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4770.45,"maximum":4770.45,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4770.45},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":4770.45}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"1 through 10","median_amount":3655.13,"10th_percentile":3655.13,"90th_percentile":3655.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"1 through 10","median_amount":13273.32,"10th_percentile":13273.32,"90th_percentile":13273.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section With Sterilization Without Cc/Mcc","code_information":[{"code":"785","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4310.1,"maximum":4310.1,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4310.1},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":4310.1}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":6164.25,"10th_percentile":6164.25,"90th_percentile":6164.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":6349.18,"10th_percentile":6349.18,"90th_percentile":6349.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section Without Sterilization With Mcc","code_information":[{"code":"786","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7422.75,"maximum":7422.75,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7422.75},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7422.75}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"1 through 10","median_amount":13725.7,"10th_percentile":13725.7,"90th_percentile":13725.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section Without Sterilization With Cc","code_information":[{"code":"787","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5025.6,"maximum":5025.6,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5025.6},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":5025.6}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"1 through 10","median_amount":7351.61,"10th_percentile":7351.61,"90th_percentile":7351.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":5973.65,"10th_percentile":5973.65,"90th_percentile":5973.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section Without Sterilization Without Cc/Mcc","code_information":[{"code":"788","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4314.6,"maximum":4314.6,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4314.6},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":4314.6}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"1 through 10","median_amount":3582.95,"10th_percentile":3582.95,"90th_percentile":3582.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"1 through 10","median_amount":9824.2,"10th_percentile":9824.2,"90th_percentile":13678.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neonates, Died Or Transferred To Another Acute Care Facility","code_information":[{"code":"789","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8109.9,"maximum":8109.9,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8109.9},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":8109.9}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"1 through 10","median_amount":1136.25,"10th_percentile":1136.25,"90th_percentile":1136.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":1261.01,"10th_percentile":1261.01,"90th_percentile":1261.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extreme Immaturity Or Respiratory Distress Syndrome, Neonate","code_information":[{"code":"790","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26745.75,"maximum":26745.75,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26745.75},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":26745.75}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prematurity With Major Problems","code_information":[{"code":"791","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18265.5,"maximum":18265.5,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18265.5},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":18265.5}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prematurity Without Major Problems","code_information":[{"code":"792","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11021.4,"maximum":11021.4,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11021.4},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":11021.4}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":2671.95,"10th_percentile":2671.95,"90th_percentile":2671.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Full Term Neonate With Major Problems","code_information":[{"code":"793","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18763.2,"maximum":18763.2,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18763.2},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":18763.2}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":2001.33,"10th_percentile":2001.33,"90th_percentile":2001.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neonate With Other Significant Problems","code_information":[{"code":"794","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6641.55,"maximum":6641.55,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6641.55},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6641.55}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":2001.33,"10th_percentile":2001.33,"90th_percentile":2499.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Normal Newborn","code_information":[{"code":"795","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":899.1,"maximum":899.1,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":899.1},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":899.1}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":2001.33,"10th_percentile":2001.33,"90th_percentile":2001.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":1943.04,"10th_percentile":1943.04,"90th_percentile":1943.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery With Sterilization And/Or D&C With Mcc","code_information":[{"code":"796","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5251.5,"maximum":5251.5,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5251.5},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":5251.5}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery With Sterilization And/Or D&C With Cc","code_information":[{"code":"797","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4501.8,"maximum":4501.8,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4501.8},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":4501.8}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"1 through 10","median_amount":6658.92,"10th_percentile":6658.92,"90th_percentile":6658.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery With Sterilization And/Or D&C Without Cc/Mcc","code_information":[{"code":"798","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4306.95,"maximum":4306.95,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4306.95},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":4306.95}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"1 through 10","median_amount":4231.36,"10th_percentile":4231.36,"90th_percentile":4231.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"1 through 10","median_amount":11364.58,"10th_percentile":11364.58,"90th_percentile":11364.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Splenic Procedures With Mcc","code_information":[{"code":"799","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20380.05,"maximum":20380.05,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20380.05},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":20380.05}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Splenic Procedures With Cc","code_information":[{"code":"800","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12642.3,"maximum":12642.3,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12642.3},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":12642.3}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Splenic Procedures Without Cc/Mcc","code_information":[{"code":"801","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8590.05,"maximum":8590.05,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8590.05},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":8590.05}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures Of The Blood And Blood Forming Organs With Mcc","code_information":[{"code":"802","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17928.45,"maximum":17928.45,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17928.45},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":17928.45}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc","code_information":[{"code":"803","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8365.05,"maximum":8365.05,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8365.05},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":8365.05}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/Mcc","code_information":[{"code":"804","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6102.0,"maximum":6102.0,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6102.0},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6102.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery Without Sterilization Or D&C With Mcc","code_information":[{"code":"805","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4856.4,"maximum":4856.4,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4856.4},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":4856.4}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":5240.52,"10th_percentile":5240.52,"90th_percentile":5240.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery Without Sterilization Or D&C With Cc","code_information":[{"code":"806","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3393.0,"maximum":3393.0,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3393.0},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":3393.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":4756.2,"10th_percentile":4756.2,"90th_percentile":4756.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"1 through 10","median_amount":4995.91,"10th_percentile":4995.91,"90th_percentile":4995.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc","code_information":[{"code":"807","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3033.9,"maximum":3033.9,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3033.9},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":3033.9}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"1 through 10","median_amount":3248.78,"10th_percentile":3248.78,"90th_percentile":3248.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"12","median_amount":4856.53,"10th_percentile":4856.53,"90th_percentile":5342.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"12","median_amount":6043.07,"10th_percentile":3959.72,"90th_percentile":7105.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":5240.52,"10th_percentile":5240.52,"90th_percentile":5240.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"1 through 10","median_amount":9847.76,"10th_percentile":9847.76,"90th_percentile":9847.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"1 through 10","median_amount":500.0,"10th_percentile":500.0,"90th_percentile":500.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"1 through 10","median_amount":6329.92,"10th_percentile":5729.1,"90th_percentile":10458.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","code_information":[{"code":"808","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9935.55,"maximum":9935.55,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9935.55},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":9935.55}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"1 through 10","median_amount":20197.44,"10th_percentile":20197.44,"90th_percentile":20197.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","code_information":[{"code":"809","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5696.55,"maximum":5696.55,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5696.55},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":5696.55}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","code_information":[{"code":"810","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4709.7,"maximum":4709.7,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4709.7},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":4709.7}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Red Blood Cell Disorders With Mcc","code_information":[{"code":"811","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6319.35,"maximum":6319.35,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6319.35},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6319.35}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":16111.31,"10th_percentile":16111.31,"90th_percentile":16111.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Red Blood Cell Disorders Without Mcc","code_information":[{"code":"812","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4131.9,"maximum":4131.9,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4131.9},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":4131.9}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":16109.83,"10th_percentile":16109.83,"90th_percentile":16109.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"1 through 10","median_amount":5013.41,"10th_percentile":5013.41,"90th_percentile":5013.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coagulation Disorders","code_information":[{"code":"813","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6863.85,"maximum":6863.85,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6863.85},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6863.85}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"1 through 10","median_amount":51827.33,"10th_percentile":51827.33,"90th_percentile":51827.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Reticuloendothelial And Immunity Disorders With Mcc","code_information":[{"code":"814","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9570.15,"maximum":9570.15,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9570.15},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":9570.15}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Reticuloendothelial And Immunity Disorders With Cc","code_information":[{"code":"815","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4563.0,"maximum":4563.0,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4563.0},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":4563.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Reticuloendothelial And Immunity Disorders Without Cc/Mcc","code_information":[{"code":"816","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2844.0,"maximum":2844.0,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2844.0},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":2844.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Procedures With Mcc","code_information":[{"code":"817","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10267.2,"maximum":10267.2,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10267.2},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":10267.2}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Procedures With Mcc","code_information":[{"code":"820","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26391.6,"maximum":26391.6,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26391.6},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":26391.6}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Procedures With Cc","code_information":[{"code":"821","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10073.7,"maximum":10073.7,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10073.7},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":10073.7}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Procedures Without Cc/Mcc","code_information":[{"code":"822","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5418.0,"maximum":5418.0,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5418.0},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":5418.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Other Procedures With Mcc","code_information":[{"code":"823","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20631.6,"maximum":20631.6,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20631.6},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":20631.6}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Other Procedures With Cc","code_information":[{"code":"824","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10195.2,"maximum":10195.2,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10195.2},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":10195.2}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/Mcc","code_information":[{"code":"825","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6072.3,"maximum":6072.3,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6072.3},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6072.3}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Procedures With Mcc","code_information":[{"code":"826","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21050.1,"maximum":21050.1,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21050.1},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":21050.1}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Procedures With Cc","code_information":[{"code":"827","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10400.4,"maximum":10400.4,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10400.4},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":10400.4}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Procedures Without C","code_information":[{"code":"828","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7667.1,"maximum":7667.1,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7667.1},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7667.1}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/Mcc","code_information":[{"code":"829","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14220.0,"maximum":14220.0,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14220.0},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":14220.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/Mcc","code_information":[{"code":"830","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6772.5,"maximum":6772.5,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6772.5},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6772.5}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses Without O.R. Procedures With Mcc","code_information":[{"code":"831","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5411.25,"maximum":5411.25,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5411.25},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":5411.25}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses Without O.R. Procedures With Cc","code_information":[{"code":"832","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3247.2,"maximum":3247.2,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3247.2},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":3247.2}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"1 through 10","median_amount":2690.64,"10th_percentile":2690.64,"90th_percentile":2690.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses Without O.R. Procedures Without Cc/Mcc","code_information":[{"code":"833","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2353.05,"maximum":2353.05,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2353.05},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":2353.05}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Leukemia With Mcc","code_information":[{"code":"834","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24704.55,"maximum":24704.55,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24704.55},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":24704.55}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Leukemia With Cc","code_information":[{"code":"835","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9386.1,"maximum":9386.1,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9386.1},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":9386.1}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Leukemia Without Cc/Mcc","code_information":[{"code":"836","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5487.75,"maximum":5487.75,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5487.75},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":5487.75}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemotherapy Agent With Mc","code_information":[{"code":"837","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21619.35,"maximum":21619.35,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21619.35},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":21619.35}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent","code_information":[{"code":"838","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9393.3,"maximum":9393.3,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9393.3},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":9393.3}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/Mcc","code_information":[{"code":"839","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6497.55,"maximum":6497.55,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6497.55},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6497.55}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Mcc","code_information":[{"code":"840","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14557.05,"maximum":14557.05,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14557.05},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":14557.05}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Cc","code_information":[{"code":"841","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7341.3,"maximum":7341.3,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7341.3},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7341.3}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia Without Cc/Mcc","code_information":[{"code":"842","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4546.8,"maximum":4546.8,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4546.8},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":4546.8}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Mcc","code_information":[{"code":"843","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8976.6,"maximum":8976.6,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8976.6},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":8976.6}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc","code_information":[{"code":"844","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5478.3,"maximum":5478.3,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5478.3},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":5478.3}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses Without Cc/Mcc","code_information":[{"code":"845","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3832.2,"maximum":3832.2,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3832.2},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":3832.2}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Mcc","code_information":[{"code":"846","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11666.25,"maximum":11666.25,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11666.25},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":11666.25}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc","code_information":[{"code":"847","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5886.9,"maximum":5886.9,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5886.9},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":5886.9}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/Mcc","code_information":[{"code":"848","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3822.3,"maximum":3822.3,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3822.3},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":3822.3}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Radiotherapy","code_information":[{"code":"849","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12192.75,"maximum":12192.75,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12192.75},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":12192.75}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Leukemia With Other Procedures","code_information":[{"code":"850","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":38967.75,"maximum":38967.75,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38967.75},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":38967.75}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infectious And Parasitic Diseases With O.R. Procedures With Mcc","code_information":[{"code":"853","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22223.7,"maximum":22223.7,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22223.7},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":22223.7}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Procedures With Cc","code_information":[{"code":"854","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8991.45,"maximum":8991.45,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8991.45},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":8991.45}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Procedures Without Cc/Mcc","code_information":[{"code":"855","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6737.4,"maximum":6737.4,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6737.4},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6737.4}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. 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Procedures With Mcc","code_information":[{"code":"856","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20469.15,"maximum":20469.15,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20469.15},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":20469.15}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc","code_information":[{"code":"857","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9636.75,"maximum":9636.75,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9636.75},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":9636.75}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/Mcc","code_information":[{"code":"858","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6268.05,"maximum":6268.05,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6268.05},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6268.05}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postoperative And Post-Traumatic Infections With Mcc","code_information":[{"code":"862","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8206.65,"maximum":8206.65,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8206.65},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":8206.65}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postoperative And Post-Traumatic Infections Without Mcc","code_information":[{"code":"863","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4490.55,"maximum":4490.55,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4490.55},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":4490.55}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"1 through 10","median_amount":16297.53,"10th_percentile":16297.53,"90th_percentile":16297.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"1 through 10","median_amount":7473.5,"10th_percentile":7473.5,"90th_percentile":7473.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"1 through 10","median_amount":2986.42,"10th_percentile":2986.42,"90th_percentile":2986.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fever And Inflammatory Conditions","code_information":[{"code":"864","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3994.65,"maximum":3994.65,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3994.65},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":3994.65}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Viral Illness With Mcc","code_information":[{"code":"865","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6742.35,"maximum":6742.35,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6742.35},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6742.35}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Viral Illness Without Mcc","code_information":[{"code":"866","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3913.2,"maximum":3913.2,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3913.2},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":3913.2}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"1 through 10","median_amount":2101.19,"10th_percentile":2101.19,"90th_percentile":2101.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Infectious And Parasitic Diseases Diagnoses With Mcc","code_information":[{"code":"867","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9419.4,"maximum":9419.4,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9419.4},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":9419.4}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Infectious And Parasitic Diseases Diagnoses With Cc","code_information":[{"code":"868","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4639.95,"maximum":4639.95,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4639.95},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":4639.95}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Infectious And Parasitic Diseases Diagnoses Without Cc/Mcc","code_information":[{"code":"869","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3283.65,"maximum":3283.65,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3283.65},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":3283.65}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septicemia Or Severe Sepsis With Mv >96 Hours","code_information":[{"code":"870","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":31103.1,"maximum":31103.1,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31103.1},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":31103.1}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc","code_information":[{"code":"871","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8741.25,"maximum":8741.25,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8741.25},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":8741.25}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"1 through 10","median_amount":9602.01,"10th_percentile":9602.01,"90th_percentile":9602.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"1 through 10","median_amount":3189.5,"10th_percentile":3189.5,"90th_percentile":3189.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc","code_information":[{"code":"872","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4604.85,"maximum":4604.85,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4604.85},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":4604.85}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":22506.84,"10th_percentile":22506.84,"90th_percentile":22506.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":4780.73,"10th_percentile":4780.73,"90th_percentile":4780.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures With Principal Diagnosis Of Mental Illness","code_information":[{"code":"876","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17392.05,"maximum":17392.05,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17392.05},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":17392.05}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"1 through 10","median_amount":44652.97,"10th_percentile":44652.97,"90th_percentile":44652.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Adjustment Reaction And Psychosocial Dysfunction","code_information":[{"code":"880","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4320.9,"maximum":4320.9,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4320.9},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":4320.9}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Depressive Neuroses","code_information":[{"code":"881","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4234.05,"maximum":4234.05,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4234.05},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":4234.05}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neuroses Except Depressive","code_information":[{"code":"882","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4832.1,"maximum":4832.1,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4832.1},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":4832.1}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":10523.41,"10th_percentile":10523.41,"90th_percentile":10523.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Personality And Impulse Control","code_information":[{"code":"883","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8848.35,"maximum":8848.35,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8848.35},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":8848.35}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Organic Disturbances And Intellectual Disability","code_information":[{"code":"884","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7240.05,"maximum":7240.05,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7240.05},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7240.05}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"1 through 10","median_amount":19172.99,"10th_percentile":19172.99,"90th_percentile":19172.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"1 through 10","median_amount":4000.0,"10th_percentile":4000.0,"90th_percentile":4800.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Psychoses","code_information":[{"code":"885","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6285.6,"maximum":6285.6,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6285.6},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6285.6}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":16109.83,"10th_percentile":16109.83,"90th_percentile":41831.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"1 through 10","median_amount":33465.0,"10th_percentile":16732.5,"90th_percentile":36811.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"1 through 10","median_amount":10627.3,"10th_percentile":5074.56,"90th_percentile":11830.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"1 through 10","median_amount":28721.68,"10th_percentile":28721.68,"90th_percentile":28721.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"1 through 10","median_amount":9666.79,"10th_percentile":9664.39,"90th_percentile":67569.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":9277.66,"10th_percentile":9277.66,"90th_percentile":9277.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":10627.3,"10th_percentile":10627.3,"90th_percentile":11838.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"1 through 10","median_amount":6752.9,"10th_percentile":6752.9,"90th_percentile":6794.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"1 through 10","median_amount":10137.63,"10th_percentile":10137.63,"90th_percentile":10137.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"1 through 10","median_amount":4377.22,"10th_percentile":4377.22,"90th_percentile":4377.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"1 through 10","median_amount":1320.0,"10th_percentile":1320.0,"90th_percentile":1320.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Behavioral And Developmental Disorders","code_information":[{"code":"886","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9338.85,"maximum":9338.85,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9338.85},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":9338.85}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alcohol, Drug Abuse Or Dependence, Left Ama","code_information":[{"code":"894","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2776.05,"maximum":2776.05,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2776.05},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":2776.05}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":3405.99,"10th_percentile":3405.99,"90th_percentile":3405.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"1 through 10","median_amount":3568.31,"10th_percentile":3568.31,"90th_percentile":3568.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alcohol, Drug Abuse Or Dependence With Rehabilitation Therapy","code_information":[{"code":"895","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6370.2,"maximum":6370.2,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6370.2},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6370.2}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc","code_information":[{"code":"896","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7852.95,"maximum":7852.95,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7852.95},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7852.95}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc","code_information":[{"code":"897","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3972.6,"maximum":3972.6,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3972.6},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":3972.6}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"1 through 10","median_amount":4481.91,"10th_percentile":3969.9,"90th_percentile":7168.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":5290.06,"10th_percentile":5290.06,"90th_percentile":5290.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":5064.06,"10th_percentile":5064.06,"90th_percentile":5064.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"1 through 10","median_amount":4915.13,"10th_percentile":4915.13,"90th_percentile":4915.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"1 through 10","median_amount":4690.93,"10th_percentile":4690.93,"90th_percentile":4690.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"1 through 10","median_amount":5554.56,"10th_percentile":5317.26,"90th_percentile":7223.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"1 through 10","median_amount":16879.82,"10th_percentile":16879.82,"90th_percentile":16879.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"1 through 10","median_amount":2069.31,"10th_percentile":2069.31,"90th_percentile":2069.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridements For Injuries With Mcc","code_information":[{"code":"901","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18884.7,"maximum":18884.7,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18884.7},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":18884.7}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridements For Injuries With Cc","code_information":[{"code":"902","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8615.25,"maximum":8615.25,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8615.25},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":8615.25}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridements For Injuries Without Cc/Mcc","code_information":[{"code":"903","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5263.2,"maximum":5263.2,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5263.2},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":5263.2}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts For Injuries With Cc/Mcc","code_information":[{"code":"904","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16528.95,"maximum":16528.95,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16528.95},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":16528.95}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts For Injuries Without Cc/Mcc","code_information":[{"code":"905","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6675.3,"maximum":6675.3,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6675.3},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6675.3}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hand Procedures For Injuries","code_information":[{"code":"906","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8839.35,"maximum":8839.35,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8839.35},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":8839.35}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"1 through 10","median_amount":10201.33,"10th_percentile":10201.33,"90th_percentile":10201.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Injuries With Mcc","code_information":[{"code":"907","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17276.85,"maximum":17276.85,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17276.85},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":17276.85}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Injuries With Cc","code_information":[{"code":"908","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8978.4,"maximum":8978.4,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8978.4},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":8978.4}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Injuries Without Cc/Mcc","code_information":[{"code":"909","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5907.15,"maximum":5907.15,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5907.15},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":5907.15}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Injury With Mcc","code_information":[{"code":"913","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7355.7,"maximum":7355.7,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7355.7},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7355.7}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Injury Without Mcc","code_information":[{"code":"914","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3984.75,"maximum":3984.75,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3984.75},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":3984.75}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Allergic Reactions With Mcc","code_information":[{"code":"915","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7567.2,"maximum":7567.2,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7567.2},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7567.2}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Allergic Reactions Without Mcc","code_information":[{"code":"916","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2998.35,"maximum":2998.35,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2998.35},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":2998.35}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Poisoning And Toxic Effects Of Drugs With Mcc","code_information":[{"code":"917","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7057.8,"maximum":7057.8,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7057.8},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7057.8}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Poisoning And Toxic Effects Of Drugs Without Mcc","code_information":[{"code":"918","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3856.95,"maximum":3856.95,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3856.95},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":3856.95}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complications Of Treatment With Mcc","code_information":[{"code":"919","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8238.6,"maximum":8238.6,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8238.6},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":8238.6}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complications Of Treatment With Cc","code_information":[{"code":"920","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4510.35,"maximum":4510.35,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4510.35},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":4510.35}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"1 through 10","median_amount":9587.09,"10th_percentile":9587.09,"90th_percentile":9587.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complications Of Treatment Without Cc/Mcc","code_information":[{"code":"921","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3097.8,"maximum":3097.8,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3097.8},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":3097.8}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Injury, Poisoning And Toxic Effect Diagnoses With Mcc","code_information":[{"code":"922","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7872.3,"maximum":7872.3,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7872.3},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7872.3}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Injury, Poisoning And Toxic Effect Diagnoses Without Mcc","code_information":[{"code":"923","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4579.65,"maximum":4579.65,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4579.65},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":4579.65}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft","code_information":[{"code":"927","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":96077.25,"maximum":96077.25,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":96077.25},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":96077.25}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc","code_information":[{"code":"928","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32277.15,"maximum":32277.15,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32277.15},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":32277.15}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/Mcc","code_information":[{"code":"929","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14493.6,"maximum":14493.6,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14493.6},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":14493.6}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft","code_information":[{"code":"933","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17523.9,"maximum":17523.9,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17523.9},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":17523.9}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Full Thickness Burn Without Skin Graft Or Inhalation Injury","code_information":[{"code":"934","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9947.7,"maximum":9947.7,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9947.7},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":9947.7}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Extensive Burns","code_information":[{"code":"935","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9270.0,"maximum":9270.0,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9270.0},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":9270.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures With Diagnoses Of Other Contact With Health Services With Mcc","code_information":[{"code":"939","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16328.25,"maximum":16328.25,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16328.25},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":16328.25}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc","code_information":[{"code":"940","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10516.05,"maximum":10516.05,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10516.05},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":10516.05}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/Mcc","code_information":[{"code":"941","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9124.65,"maximum":9124.65,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9124.65},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":9124.65}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rehabilitation With Cc/Mcc","code_information":[{"code":"945","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6968.7,"maximum":6968.7,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6968.7},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6968.7}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rehabilitation Without Cc/Mcc","code_information":[{"code":"946","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5160.6,"maximum":5160.6,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5160.6},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":5160.6}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Signs And Symptoms With Mcc","code_information":[{"code":"947","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5712.3,"maximum":5712.3,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5712.3},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":5712.3}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Signs And Symptoms Without Mcc","code_information":[{"code":"948","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3602.25,"maximum":3602.25,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3602.25},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":3602.25}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare With Cc/Mcc","code_information":[{"code":"949","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5353.65,"maximum":5353.65,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5353.65},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":5353.65}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare Without Cc/Mcc","code_information":[{"code":"950","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2824.65,"maximum":2824.65,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2824.65},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":2824.65}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Factors Influencing Health Status","code_information":[{"code":"951","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2502.0,"maximum":2502.0,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2502.0},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":2502.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy For Multiple Significant Trauma","code_information":[{"code":"955","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30289.95,"maximum":30289.95,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30289.95},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":30289.95}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma","code_information":[{"code":"956","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16933.5,"maximum":16933.5,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16933.5},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":16933.5}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Multiple Significant Trauma With Mcc","code_information":[{"code":"957","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":34289.55,"maximum":34289.55,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34289.55},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":34289.55}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Multiple Significant Trauma With Cc","code_information":[{"code":"958","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18962.55,"maximum":18962.55,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18962.55},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":18962.55}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Multiple Significant Trauma Without Cc/Mcc","code_information":[{"code":"959","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13248.45,"maximum":13248.45,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13248.45},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":13248.45}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Multiple Significant Trauma With Mcc","code_information":[{"code":"963","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12302.1,"maximum":12302.1,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12302.1},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":12302.1}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Multiple Significant Trauma With Cc","code_information":[{"code":"964","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6896.7,"maximum":6896.7,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6896.7},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":6896.7}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Multiple Significant Trauma Without Cc/Mcc","code_information":[{"code":"965","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4232.25,"maximum":4232.25,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4232.25},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":4232.25}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Extensive O.R. Procedures With Mcc","code_information":[{"code":"969","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27545.85,"maximum":27545.85,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27545.85},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":27545.85}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Extensive O.R. Procedures Without Mcc","code_information":[{"code":"970","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11868.3,"maximum":11868.3,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11868.3},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":11868.3}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Major Related Condition With Mcc","code_information":[{"code":"974","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12987.0,"maximum":12987.0,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12987.0},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":12987.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Major Related Condition With Cc","code_information":[{"code":"975","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5827.5,"maximum":5827.5,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5827.5},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":5827.5}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Major Related Condition Without Cc/Mcc","code_information":[{"code":"976","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4062.15,"maximum":4062.15,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4062.15},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":4062.15}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Or Without Other Related Condition","code_information":[{"code":"977","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5839.65,"maximum":5839.65,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5839.65},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":5839.65}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","code_information":[{"code":"981","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21113.1,"maximum":21113.1,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21113.1},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":21113.1}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","code_information":[{"code":"982","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11063.25,"maximum":11063.25,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11063.25},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":11063.25}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","code_information":[{"code":"983","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7713.0,"maximum":7713.0,"payers_information":[{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7713.0},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"fee schedule","standard_charge_dollar":7713.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bone marrow transplant","code_information":[{"code":"009","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hyphema","code_information":[{"code":"043","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Major Eye Infections","code_information":[{"code":"044","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neurological eye disorders","code_information":[{"code":"045","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders of the Eye Age >17 w CC","code_information":[{"code":"046","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders of the Eye Age >17 w/o CC","code_information":[{"code":"047","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders of the Eye Age 0-17","code_information":[{"code":"048","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head & Neck Procedures","code_information":[{"code":"049","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sialoadenectomy","code_information":[{"code":"050","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Salivary Gland Procedures Except Sialoadenectomy","code_information":[{"code":"051","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertensive Encephalopathy With Mcc","code_information":[{"code":"077","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertensive Encephalopathy With Cc","code_information":[{"code":"078","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertensive Encephalopathy Without Cc/Mcc","code_information":[{"code":"079","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve & Oth Major Cardiothoracic Proc w Cardiac Cath","code_information":[{"code":"104","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve & Oth Major Cardiothoracic Proc w/o Cardiac Cath","code_information":[{"code":"105","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass w PTCA","code_information":[{"code":"106","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"107","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cardiothoracic Procedures","code_information":[{"code":"108","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"109","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Cardiovascular Procedures w CC","code_information":[{"code":"110","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Cardiovascular Procedures w/o CC","code_information":[{"code":"111","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"112","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Device Replacement","code_information":[{"code":"118","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vein ligation & stripping","code_information":[{"code":"119","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other circulatory system O.R. procedures","code_information":[{"code":"120","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute & Subacute Endocarditis","code_information":[{"code":"126","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Failure & Shock","code_information":[{"code":"127","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Deep Vein Thrombophlebitis","code_information":[{"code":"128","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head & Neck Procedures W Cc/Mcc Or Major Device","code_information":[{"code":"129","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head & Neck Procedures W/O Cc/Mcc","code_information":[{"code":"130","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cranial/Facial Procedures W Cc/Mcc","code_information":[{"code":"131","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cranial/Facial Procedures W/O Cc/Mcc","code_information":[{"code":"132","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/Mcc","code_information":[{"code":"133","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/Mcc","code_information":[{"code":"134","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hernia Procedures Except Inguinal & Femoral Age >17 w/o CC","code_information":[{"code":"160","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal & Femoral Hernia Procedures Age >17 w CC","code_information":[{"code":"161","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal & Femoral Hernia Procedures Age >17 w/o CC","code_information":[{"code":"162","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mouth Procedures w/o CC","code_information":[{"code":"169","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System O.R. Procedures w/o CC","code_information":[{"code":"171","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"G.I. hemorrhage w CC","code_information":[{"code":"174","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip & Femur Procedures Except Major Joint Age >17 w CC","code_information":[{"code":"210","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip & Femur Procedures Except Major Joint Age >17 w/o CC","code_information":[{"code":"211","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"214","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With Mcc","code_information":[{"code":"222","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without Mcc","code_information":[{"code":"223","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With Mcc","code_information":[{"code":"224","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without Mcc","code_information":[{"code":"225","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc","code_information":[{"code":"226","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc","code_information":[{"code":"227","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other cardiothoracic procedures w/o CC/MCC","code_information":[{"code":"230","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major cardiovasc procedures w MCC","code_information":[{"code":"237","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major cardiovasc procedures w/o MCC","code_information":[{"code":"238","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents","code_information":[{"code":"246","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without Mcc","code_information":[{"code":"247","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents","code_information":[{"code":"248","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without Mcc","code_information":[{"code":"249","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Deep Vein Thrombophlebitis With Cc/Mcc","code_information":[{"code":"294","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Deep Vein Thrombophlebitis Without Cc/Mcc","code_information":[{"code":"295","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy With Complicated Principal Diagnosis With Mcc","code_information":[{"code":"338","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy With Complicated Principal Diagnosis With Cc","code_information":[{"code":"339","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy With Complicated Principal Diagnosis Without Cc/Mcc","code_information":[{"code":"340","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy Without Complicated Principal Diagnosis With Mcc","code_information":[{"code":"341","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy Without Complicated Principal Diagnosis With Cc","code_information":[{"code":"342","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy Without Complicated Principal Diagnosis Without Cc/Mcc","code_information":[{"code":"343","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Laparoscopy & Incisional Tubal Interruption","code_information":[{"code":"361","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endoscopic Tubal Interruption","code_information":[{"code":"362","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"D&C, Conization & Radio-Implant, for Malignancy","code_information":[{"code":"363","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"D&C, Conization Except for Malignancy","code_information":[{"code":"364","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Female Reproductive System O.R. Procedures","code_information":[{"code":"365","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, female reproductive system w CC","code_information":[{"code":"366","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Female Reproductive System w/o CC","code_information":[{"code":"367","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Red Blood Cell Disorders Age 0-17","code_information":[{"code":"396","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"400","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma & non-acute leukemia w other O.R. proc w CC","code_information":[{"code":"401","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma & non-acute leukemia w CC","code_information":[{"code":"403","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma & Non-Acute Leukemia w/o CC","code_information":[{"code":"404","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Childhood Mental Disorders","code_information":[{"code":"431","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Poisoning & toxic Effects of Drugs Age >17 w CC","code_information":[{"code":"449","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complications of treatment w CC","code_information":[{"code":"452","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Spinal Fusion With Mcc","code_information":[{"code":"453","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Spinal Fusion With Cc","code_information":[{"code":"454","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc","code_information":[{"code":"455","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical With Mcc","code_information":[{"code":"459","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical Without Mcc","code_information":[{"code":"460","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major joint & limb reattachment proc of upper extremity w/o CC/MCC","code_information":[{"code":"484","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back & neck proc exc spinal fusion w CC/MCC or disc device/neurostim","code_information":[{"code":"490","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back & neck proc exc spinal fusion w/o CC/MCC","code_information":[{"code":"491","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Arthroscopy","code_information":[{"code":"509","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alc/Drug Abuse or Depend w/o Rehabilitation therapy w/o CC","code_information":[{"code":"523","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transient ischemia","code_information":[{"code":"524","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other heart assist system implant","code_information":[{"code":"525","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"526","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"527","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Vascular Proc w Pdx Hemorrhage","code_information":[{"code":"528","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular shunt procedures w CC","code_information":[{"code":"529","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular Shunt Procedures w/o CC","code_information":[{"code":"530","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures w CC","code_information":[{"code":"531","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures w/o CC","code_information":[{"code":"532","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal & Duodenal Proc Age > 17 w CC w Major Gi Dx","code_information":[{"code":"567","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal & Duodenal Procedures Proc Age > 17 w CC w/o Major Gi Dx","code_information":[{"code":"568","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Small & Large Bowel Procedures w CC w Major Gi Dx","code_information":[{"code":"569","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Admit For Renal Dialysis","code_information":[{"code":"685","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urinary Stones W Esw Lithotripsy W Cc/Mcc","code_information":[{"code":"691","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urinary Stones W Esw Lithotripsy W/O Cc/Mcc","code_information":[{"code":"692","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section W Cc/Mcc","code_information":[{"code":"765","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section W/O Cc/Mcc","code_information":[{"code":"766","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery W Sterilization &/Or D&C","code_information":[{"code":"767","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery W Complicating Diagnoses","code_information":[{"code":"774","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery W/O Complicating Diagnoses","code_information":[{"code":"775","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ectopic Pregnancy","code_information":[{"code":"777","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Threatened Abortion","code_information":[{"code":"778","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"False Labor","code_information":[{"code":"780","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses W Medical Complications","code_information":[{"code":"781","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses W/O Medical Complications","code_information":[{"code":"782","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Mcc","code_information":[{"code":"984","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Cc","code_information":[{"code":"985","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W/O Cc/Mcc","code_information":[{"code":"986","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Principal Diagnosis Invalid As Discharge Diagnosis","code_information":[{"code":"998","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ungroupable","code_information":[{"code":"999","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 84] [All Other IP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4161.89] [Surgical-Per Diem: 4161.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 70900 | Total % of Charge: 58.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Medical-Per Diem: 1872]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4080.2] [Surgical-Per Diem: 4080.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 79.2] [All Other IP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 88] [All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 3590.21] [Surgical-Per Diem: 3590.21]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 76] [All Other IP (%BC): 76]","count":"1 through 10","median_amount":36563.19,"10th_percentile":36563.19,"90th_percentile":36563.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 75] [All Other IP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 72] [All Other IP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 89] [All Other IP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Injection,onabotulinumtoxinA","code_information":[{"code":"0902","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 84] [OP Surgery  (%BC): 84] [Observation (%BC): 84] [Emergency Department (%BC): 84] [Occupational Therapy (%BC): 84] [Physical Therapy (%BC): 84] [Respiratory Services/Therapy  (%BC): 84] [Speech Therapy (%BC): 84] [All Other OP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41.82] [OP Surgery  (%BC): 41.82] [Observation (%BC): 41.82] [Emergency Department (%BC): 41.82] [Occupational Therapy (%BC): 41.82] [Physical Therapy (%BC): 41.82] [Respiratory Services/Therapy  (%BC): 41.82] [Speech Therapy (%BC): 41.82] [All Other OP (%BC): 41.82]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [All OP services (%BC): 77.4] [OP Surgery  (%BC): 77.4] [Observation (%BC): 77.4] [Emergency Department (%BC): 77.4] [Occupational Therapy (%BC): 77.4] [Physical Therapy (%BC): 77.4] [Respiratory Services/Therapy  (%BC): 77.4] [Speech Therapy (%BC): 77.4] [All Other OP (%BC): 77.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41] [OP Surgery  (%BC): 41] [Observation (%BC): 41] [Emergency Department (%BC): 41] [Occupational Therapy (%BC): 41] [Physical Therapy (%BC): 41] [Respiratory Services/Therapy  (%BC): 41] [Speech Therapy (%BC): 41] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 60.6] [OP Surgery  (%BC): 60.6] [Observation (%BC): 60.6] [Emergency Department (%BC): 60.6] [Occupational Therapy (%BC): 60.6] [Physical Therapy (%BC): 60.6] [Respiratory Services/Therapy  (%BC): 60.6] [Speech Therapy (%BC): 60.6] [All Other OP (%BC): 60.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Bluecard Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [Emergency Department ($): 40]","count":"1 through 10","median_amount":1300.0,"10th_percentile":1300.0,"90th_percentile":1300.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 79.2] [OP Surgery  (%BC): 79.2] [Observation (%BC): 79.2] [Emergency Department (%BC): 79.2] [Occupational Therapy (%BC): 79.2] [Physical Therapy (%BC): 79.2] [Respiratory Services/Therapy  (%BC): 79.2] [Speech Therapy (%BC): 79.2] [All Other OP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74] [Observation (%BC): 74] [Emergency Department (%BC): 74] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 74] [Physical Therapy (%BC): 74] [Respiratory Services/Therapy  (%BC): 74] [Speech Therapy (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 78] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 39] [OP Surgery  (%BC): 39] [Observation (%BC): 39] [Emergency Department (%BC): 39] [Occupational Therapy (%BC): 39] [Physical Therapy (%BC): 39] [Respiratory Services/Therapy  (%BC): 39] [Speech Therapy (%BC): 39] [All Other OP (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Mycare Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 75] [OP Surgery  (%BC): 75] [Observation (%BC): 75] [Emergency Department (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [All Other OP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72] [OP Surgery  (%BC): 72] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 72] [Physical Therapy (%BC): 72] [Respiratory Services/Therapy  (%BC): 72] [Speech Therapy (%BC): 72] [All Other OP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [ED Level 1--99281 ($): 27.09] [ED Level 2--99282 ($): 41.69] [ED Level 3--99283 ($): 73.69] [ED Level 4--99284 ($): 123.51] [ED Level 5--99285 ($): 223.93] [Clinic Visit ($): 59.34] [OP High Cost Drugs (%BC): 40] [Other Outpatient Implant (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Clinic Visits and Related Services","code_information":[{"code":"5012","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 84] [OP Surgery  (%BC): 84] [Observation (%BC): 84] [Emergency Department (%BC): 84] [Occupational Therapy (%BC): 84] [Physical Therapy (%BC): 84] [Respiratory Services/Therapy  (%BC): 84] [Speech Therapy (%BC): 84] [All Other OP (%BC): 84]","count":"1 through 10","median_amount":163.32,"10th_percentile":119.23,"90th_percentile":427.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"46","median_amount":44.62,"10th_percentile":8.36,"90th_percentile":75.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41.82] [OP Surgery  (%BC): 41.82] [Observation (%BC): 41.82] [Emergency Department (%BC): 41.82] [Occupational Therapy (%BC): 41.82] [Physical Therapy (%BC): 41.82] [Respiratory Services/Therapy  (%BC): 41.82] [Speech Therapy (%BC): 41.82] [All Other OP (%BC): 41.82]","count":"458","median_amount":11.37,"10th_percentile":9.14,"90th_percentile":82.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":10.36,"10th_percentile":10.36,"90th_percentile":10.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [All OP services (%BC): 77.4] [OP Surgery  (%BC): 77.4] [Observation (%BC): 77.4] [Emergency Department (%BC): 77.4] [Occupational Therapy (%BC): 77.4] [Physical Therapy (%BC): 77.4] [Respiratory Services/Therapy  (%BC): 77.4] [Speech Therapy (%BC): 77.4] [All Other OP (%BC): 77.4]","count":"360","median_amount":140.01,"10th_percentile":101.35,"90th_percentile":245.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"70","median_amount":10.4,"10th_percentile":8.36,"90th_percentile":91.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41] [OP Surgery  (%BC): 41] [Observation (%BC): 41] [Emergency Department (%BC): 41] [Occupational Therapy (%BC): 41] [Physical Therapy (%BC): 41] [Respiratory Services/Therapy  (%BC): 41] [Speech Therapy (%BC): 41] [All Other OP (%BC): 41]","count":"282","median_amount":10.36,"10th_percentile":8.33,"90th_percentile":74.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 60.6] [OP Surgery  (%BC): 60.6] [Observation (%BC): 60.6] [Emergency Department (%BC): 60.6] [Occupational Therapy (%BC): 60.6] [Physical Therapy (%BC): 60.6] [Respiratory Services/Therapy  (%BC): 60.6] [Speech Therapy (%BC): 60.6] [All Other OP (%BC): 60.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Bluecard Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"54","median_amount":10.57,"10th_percentile":8.5,"90th_percentile":76.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [Emergency Department ($): 40]","count":"389","median_amount":27.11,"10th_percentile":22.98,"90th_percentile":189.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"71","median_amount":28.58,"10th_percentile":22.98,"90th_percentile":173.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 79.2] [OP Surgery  (%BC): 79.2] [Observation (%BC): 79.2] [Emergency Department (%BC): 79.2] [Occupational Therapy (%BC): 79.2] [Physical Therapy (%BC): 79.2] [Respiratory Services/Therapy  (%BC): 79.2] [Speech Therapy (%BC): 79.2] [All Other OP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74] [Observation (%BC): 74] [Emergency Department (%BC): 74] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 74] [Physical Therapy (%BC): 74] [Respiratory Services/Therapy  (%BC): 74] [Speech Therapy (%BC): 74] [All Other OP (%BC): 74]","count":"1 through 10","median_amount":106.04,"10th_percentile":106.04,"90th_percentile":106.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 78] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"108","median_amount":28.58,"10th_percentile":22.98,"90th_percentile":157.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 39] [OP Surgery  (%BC): 39] [Observation (%BC): 39] [Emergency Department (%BC): 39] [Occupational Therapy (%BC): 39] [Physical Therapy (%BC): 39] [Respiratory Services/Therapy  (%BC): 39] [Speech Therapy (%BC): 39] [All Other OP (%BC): 39]","count":"189","median_amount":8.78,"10th_percentile":0.45,"90th_percentile":72.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"73","median_amount":11.25,"10th_percentile":9.05,"90th_percentile":77.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"31","median_amount":28.58,"10th_percentile":22.98,"90th_percentile":160.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Mycare Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 75] [OP Surgery  (%BC): 75] [Observation (%BC): 75] [Emergency Department (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [All Other OP (%BC): 75]","count":"161","median_amount":10.36,"10th_percentile":8.78,"90th_percentile":74.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72] [OP Surgery  (%BC): 72] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 72] [Physical Therapy (%BC): 72] [Respiratory Services/Therapy  (%BC): 72] [Speech Therapy (%BC): 72] [All Other OP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"14","median_amount":178.1,"10th_percentile":106.82,"90th_percentile":383.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"75","median_amount":22.98,"10th_percentile":10.03,"90th_percentile":178.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [ED Level 1--99281 ($): 27.09] [ED Level 2--99282 ($): 41.69] [ED Level 3--99283 ($): 73.69] [ED Level 4--99284 ($): 123.51] [ED Level 5--99285 ($): 223.93] [Clinic Visit ($): 59.34] [OP High Cost Drugs (%BC): 40] [Other Outpatient Implant (%BC): 40]","count":"95","median_amount":27.11,"10th_percentile":22.98,"90th_percentile":154.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"228","median_amount":11.15,"10th_percentile":8.5,"90th_percentile":80.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"11","median_amount":10.93,"10th_percentile":8.78,"90th_percentile":70.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"16","median_amount":11.94,"10th_percentile":10.93,"90th_percentile":78.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 Type A ED Visits","code_information":[{"code":"5021","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 84] [OP Surgery  (%BC): 84] [Observation (%BC): 84] [Emergency Department (%BC): 84] [Occupational Therapy (%BC): 84] [Physical Therapy (%BC): 84] [Respiratory Services/Therapy  (%BC): 84] [Speech Therapy (%BC): 84] [All Other OP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41.82] [OP Surgery  (%BC): 41.82] [Observation (%BC): 41.82] [Emergency Department (%BC): 41.82] [Occupational Therapy (%BC): 41.82] [Physical Therapy (%BC): 41.82] [Respiratory Services/Therapy  (%BC): 41.82] [Speech Therapy (%BC): 41.82] [All Other OP (%BC): 41.82]","count":"1 through 10","median_amount":122.66,"10th_percentile":122.66,"90th_percentile":122.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [All OP services (%BC): 77.4] [OP Surgery  (%BC): 77.4] [Observation (%BC): 77.4] [Emergency Department (%BC): 77.4] [Occupational Therapy (%BC): 77.4] [Physical Therapy (%BC): 77.4] [Respiratory Services/Therapy  (%BC): 77.4] [Speech Therapy (%BC): 77.4] [All Other OP (%BC): 77.4]","count":"1 through 10","median_amount":102.13,"10th_percentile":97.79,"90th_percentile":285.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"1 through 10","median_amount":129.68,"10th_percentile":129.68,"90th_percentile":129.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41] [OP Surgery  (%BC): 41] [Observation (%BC): 41] [Emergency Department (%BC): 41] [Occupational Therapy (%BC): 41] [Physical Therapy (%BC): 41] [Respiratory Services/Therapy  (%BC): 41] [Speech Therapy (%BC): 41] [All Other OP (%BC): 41]","count":"1 through 10","median_amount":117.84,"10th_percentile":117.84,"90th_percentile":117.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 60.6] [OP Surgery  (%BC): 60.6] [Observation (%BC): 60.6] [Emergency Department (%BC): 60.6] [Occupational Therapy (%BC): 60.6] [Physical Therapy (%BC): 60.6] [Respiratory Services/Therapy  (%BC): 60.6] [Speech Therapy (%BC): 60.6] [All Other OP (%BC): 60.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Bluecard Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":120.25,"10th_percentile":120.25,"90th_percentile":120.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [Emergency Department ($): 40]","count":"11","median_amount":98.71,"10th_percentile":94.52,"90th_percentile":181.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":102.13,"10th_percentile":102.13,"90th_percentile":159.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 79.2] [OP Surgery  (%BC): 79.2] [Observation (%BC): 79.2] [Emergency Department (%BC): 79.2] [Occupational Therapy (%BC): 79.2] [Physical Therapy (%BC): 79.2] [Respiratory Services/Therapy  (%BC): 79.2] [Speech Therapy (%BC): 79.2] [All Other OP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74] [Observation (%BC): 74] [Emergency Department (%BC): 74] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 74] [Physical Therapy (%BC): 74] [Respiratory Services/Therapy  (%BC): 74] [Speech Therapy (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 78] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"1 through 10","median_amount":154.23,"10th_percentile":154.23,"90th_percentile":154.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 39] [OP Surgery  (%BC): 39] [Observation (%BC): 39] [Emergency Department (%BC): 39] [Occupational Therapy (%BC): 39] [Physical Therapy (%BC): 39] [Respiratory Services/Therapy  (%BC): 39] [Speech Therapy (%BC): 39] [All Other OP (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"1 through 10","median_amount":238.88,"10th_percentile":238.88,"90th_percentile":337.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":100.72,"10th_percentile":100.72,"90th_percentile":100.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Mycare Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"1 through 10","median_amount":117.46,"10th_percentile":117.46,"90th_percentile":117.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 75] [OP Surgery  (%BC): 75] [Observation (%BC): 75] [Emergency Department (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [All Other OP (%BC): 75]","count":"1 through 10","median_amount":128.38,"10th_percentile":128.38,"90th_percentile":128.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72] [OP Surgery  (%BC): 72] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 72] [Physical Therapy (%BC): 72] [Respiratory Services/Therapy  (%BC): 72] [Speech Therapy (%BC): 72] [All Other OP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"1 through 10","median_amount":280.48,"10th_percentile":280.48,"90th_percentile":280.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [ED Level 1--99281 ($): 27.09] [ED Level 2--99282 ($): 41.69] [ED Level 3--99283 ($): 73.69] [ED Level 4--99284 ($): 123.51] [ED Level 5--99285 ($): 223.93] [Clinic Visit ($): 59.34] [OP High Cost Drugs (%BC): 40] [Other Outpatient Implant (%BC): 40]","count":"1 through 10","median_amount":97.79,"10th_percentile":97.79,"90th_percentile":97.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Type A ED Visits","code_information":[{"code":"5022","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 84] [OP Surgery  (%BC): 84] [Observation (%BC): 84] [Emergency Department (%BC): 84] [Occupational Therapy (%BC): 84] [Physical Therapy (%BC): 84] [Respiratory Services/Therapy  (%BC): 84] [Speech Therapy (%BC): 84] [All Other OP (%BC): 84]","count":"1 through 10","median_amount":416.0,"10th_percentile":371.87,"90th_percentile":500.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41.82] [OP Surgery  (%BC): 41.82] [Observation (%BC): 41.82] [Emergency Department (%BC): 41.82] [Occupational Therapy (%BC): 41.82] [Physical Therapy (%BC): 41.82] [Respiratory Services/Therapy  (%BC): 41.82] [Speech Therapy (%BC): 41.82] [All Other OP (%BC): 41.82]","count":"18","median_amount":188.7,"10th_percentile":168.68,"90th_percentile":339.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [All OP services (%BC): 77.4] [OP Surgery  (%BC): 77.4] [Observation (%BC): 77.4] [Emergency Department (%BC): 77.4] [Occupational Therapy (%BC): 77.4] [Physical Therapy (%BC): 77.4] [Respiratory Services/Therapy  (%BC): 77.4] [Speech Therapy (%BC): 77.4] [All Other OP (%BC): 77.4]","count":"113","median_amount":191.53,"10th_percentile":125.16,"90th_percentile":394.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"1 through 10","median_amount":184.1,"10th_percentile":184.1,"90th_percentile":184.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41] [OP Surgery  (%BC): 41] [Observation (%BC): 41] [Emergency Department (%BC): 41] [Occupational Therapy (%BC): 41] [Physical Therapy (%BC): 41] [Respiratory Services/Therapy  (%BC): 41] [Speech Therapy (%BC): 41] [All Other OP (%BC): 41]","count":"1 through 10","median_amount":183.8,"10th_percentile":163.87,"90th_percentile":210.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 60.6] [OP Surgery  (%BC): 60.6] [Observation (%BC): 60.6] [Emergency Department (%BC): 60.6] [Occupational Therapy (%BC): 60.6] [Physical Therapy (%BC): 60.6] [Respiratory Services/Therapy  (%BC): 60.6] [Speech Therapy (%BC): 60.6] [All Other OP (%BC): 60.6]","count":"1 through 10","median_amount":309.0,"10th_percentile":279.8,"90th_percentile":886.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Bluecard Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":190.75,"10th_percentile":190.75,"90th_percentile":190.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [Emergency Department ($): 40]","count":"95","median_amount":149.68,"10th_percentile":115.27,"90th_percentile":233.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"14","median_amount":164.82,"10th_percentile":125.35,"90th_percentile":207.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 79.2] [OP Surgery  (%BC): 79.2] [Observation (%BC): 79.2] [Emergency Department (%BC): 79.2] [Occupational Therapy (%BC): 79.2] [Physical Therapy (%BC): 79.2] [Respiratory Services/Therapy  (%BC): 79.2] [Speech Therapy (%BC): 79.2] [All Other OP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74] [Observation (%BC): 74] [Emergency Department (%BC): 74] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 74] [Physical Therapy (%BC): 74] [Respiratory Services/Therapy  (%BC): 74] [Speech Therapy (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 78] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"24","median_amount":148.14,"10th_percentile":111.68,"90th_percentile":210.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 39] [OP Surgery  (%BC): 39] [Observation (%BC): 39] [Emergency Department (%BC): 39] [Occupational Therapy (%BC): 39] [Physical Therapy (%BC): 39] [Respiratory Services/Therapy  (%BC): 39] [Speech Therapy (%BC): 39] [All Other OP (%BC): 39]","count":"11","median_amount":173.22,"10th_percentile":33.52,"90th_percentile":193.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"1 through 10","median_amount":367.5,"10th_percentile":328.52,"90th_percentile":446.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":160.65,"10th_percentile":160.65,"90th_percentile":169.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Mycare Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 75] [OP Surgery  (%BC): 75] [Observation (%BC): 75] [Emergency Department (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [All Other OP (%BC): 75]","count":"1 through 10","median_amount":184.1,"10th_percentile":182.78,"90th_percentile":373.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72] [OP Surgery  (%BC): 72] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 72] [Physical Therapy (%BC): 72] [Respiratory Services/Therapy  (%BC): 72] [Speech Therapy (%BC): 72] [All Other OP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"1 through 10","median_amount":431.5,"10th_percentile":385.73,"90th_percentile":802.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"1 through 10","median_amount":428.82,"10th_percentile":195.0,"90th_percentile":441.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [ED Level 1--99281 ($): 27.09] [ED Level 2--99282 ($): 41.69] [ED Level 3--99283 ($): 73.69] [ED Level 4--99284 ($): 123.51] [ED Level 5--99285 ($): 223.93] [Clinic Visit ($): 59.34] [OP High Cost Drugs (%BC): 40] [Other Outpatient Implant (%BC): 40]","count":"14","median_amount":183.41,"10th_percentile":125.16,"90th_percentile":385.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"1 through 10","median_amount":440.0,"10th_percentile":195.0,"90th_percentile":440.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":258.86,"10th_percentile":258.86,"90th_percentile":258.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Type A ED Visits","code_information":[{"code":"5023","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 84] [OP Surgery  (%BC): 84] [Observation (%BC): 84] [Emergency Department (%BC): 84] [Occupational Therapy (%BC): 84] [Physical Therapy (%BC): 84] [Respiratory Services/Therapy  (%BC): 84] [Speech Therapy (%BC): 84] [All Other OP (%BC): 84]","count":"28","median_amount":1028.63,"10th_percentile":786.1,"90th_percentile":1556.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"23","median_amount":476.68,"10th_percentile":315.61,"90th_percentile":670.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41.82] [OP Surgery  (%BC): 41.82] [Observation (%BC): 41.82] [Emergency Department (%BC): 41.82] [Occupational Therapy (%BC): 41.82] [Physical Therapy (%BC): 41.82] [Respiratory Services/Therapy  (%BC): 41.82] [Speech Therapy (%BC): 41.82] [All Other OP (%BC): 41.82]","count":"127","median_amount":462.06,"10th_percentile":338.13,"90th_percentile":729.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [All OP services (%BC): 77.4] [OP Surgery  (%BC): 77.4] [Observation (%BC): 77.4] [Emergency Department (%BC): 77.4] [Occupational Therapy (%BC): 77.4] [Physical Therapy (%BC): 77.4] [Respiratory Services/Therapy  (%BC): 77.4] [Speech Therapy (%BC): 77.4] [All Other OP (%BC): 77.4]","count":"732","median_amount":332.6,"10th_percentile":140.01,"90th_percentile":1245.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"38","median_amount":448.26,"10th_percentile":340.73,"90th_percentile":840.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41] [OP Surgery  (%BC): 41] [Observation (%BC): 41] [Emergency Department (%BC): 41] [Occupational Therapy (%BC): 41] [Physical Therapy (%BC): 41] [Respiratory Services/Therapy  (%BC): 41] [Speech Therapy (%BC): 41] [All Other OP (%BC): 41]","count":"87","median_amount":447.38,"10th_percentile":309.69,"90th_percentile":719.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 60.6] [OP Surgery  (%BC): 60.6] [Observation (%BC): 60.6] [Emergency Department (%BC): 60.6] [Occupational Therapy (%BC): 60.6] [Physical Therapy (%BC): 60.6] [Respiratory Services/Therapy  (%BC): 60.6] [Speech Therapy (%BC): 60.6] [All Other OP (%BC): 60.6]","count":"1 through 10","median_amount":696.62,"10th_percentile":641.9,"90th_percentile":1143.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Bluecard Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"12","median_amount":482.92,"10th_percentile":378.49,"90th_percentile":596.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [Emergency Department ($): 40]","count":"459","median_amount":216.51,"10th_percentile":125.35,"90th_percentile":441.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"76","median_amount":225.38,"10th_percentile":133.97,"90th_percentile":496.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 79.2] [OP Surgery  (%BC): 79.2] [Observation (%BC): 79.2] [Emergency Department (%BC): 79.2] [Occupational Therapy (%BC): 79.2] [Physical Therapy (%BC): 79.2] [Respiratory Services/Therapy  (%BC): 79.2] [Speech Therapy (%BC): 79.2] [All Other OP (%BC): 79.2]","count":"1 through 10","median_amount":897.8,"10th_percentile":739.67,"90th_percentile":1495.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74] [Observation (%BC): 74] [Emergency Department (%BC): 74] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 74] [Physical Therapy (%BC): 74] [Respiratory Services/Therapy  (%BC): 74] [Speech Therapy (%BC): 74] [All Other OP (%BC): 74]","count":"1 through 10","median_amount":872.5,"10th_percentile":678.71,"90th_percentile":1841.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 78] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [All Other OP (%BC): 78]","count":"1 through 10","median_amount":600.05,"10th_percentile":600.05,"90th_percentile":600.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 39] [OP Surgery  (%BC): 39] [Observation (%BC): 39] [Emergency Department (%BC): 39] [Occupational Therapy (%BC): 39] [Physical Therapy (%BC): 39] [Respiratory Services/Therapy  (%BC): 39] [Speech Therapy (%BC): 39] [All Other OP (%BC): 39]","count":"45","median_amount":367.43,"10th_percentile":119.84,"90th_percentile":628.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"131","median_amount":900.99,"10th_percentile":610.19,"90th_percentile":1367.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"39","median_amount":224.5,"10th_percentile":122.84,"90th_percentile":362.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Mycare Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 75] [OP Surgery  (%BC): 75] [Observation (%BC): 75] [Emergency Department (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [All Other OP (%BC): 75]","count":"97","median_amount":560.78,"10th_percentile":339.38,"90th_percentile":1153.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72] [OP Surgery  (%BC): 72] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 72] [Physical Therapy (%BC): 72] [Respiratory Services/Therapy  (%BC): 72] [Speech Therapy (%BC): 72] [All Other OP (%BC): 72]","count":"1 through 10","median_amount":673.26,"10th_percentile":673.26,"90th_percentile":673.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"47","median_amount":1142.13,"10th_percentile":813.88,"90th_percentile":1579.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"37","median_amount":905.26,"10th_percentile":458.04,"90th_percentile":1759.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [ED Level 1--99281 ($): 27.09] [ED Level 2--99282 ($): 41.69] [ED Level 3--99283 ($): 73.69] [ED Level 4--99284 ($): 123.51] [ED Level 5--99285 ($): 223.93] [Clinic Visit ($): 59.34] [OP High Cost Drugs (%BC): 40] [Other Outpatient Implant (%BC): 40]","count":"73","median_amount":183.41,"10th_percentile":107.0,"90th_percentile":432.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"48","median_amount":592.32,"10th_percentile":335.5,"90th_percentile":1220.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"1 through 10","median_amount":688.89,"10th_percentile":688.89,"90th_percentile":688.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":576.31,"10th_percentile":404.75,"90th_percentile":734.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 4 Type A ED Visits","code_information":[{"code":"5024","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 84] [OP Surgery  (%BC): 84] [Observation (%BC): 84] [Emergency Department (%BC): 84] [Occupational Therapy (%BC): 84] [Physical Therapy (%BC): 84] [Respiratory Services/Therapy  (%BC): 84] [Speech Therapy (%BC): 84] [All Other OP (%BC): 84]","count":"45","median_amount":2762.61,"10th_percentile":1699.56,"90th_percentile":4246.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"65","median_amount":1544.21,"10th_percentile":713.57,"90th_percentile":5518.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41.82] [OP Surgery  (%BC): 41.82] [Observation (%BC): 41.82] [Emergency Department (%BC): 41.82] [Occupational Therapy (%BC): 41.82] [Physical Therapy (%BC): 41.82] [Respiratory Services/Therapy  (%BC): 41.82] [Speech Therapy (%BC): 41.82] [All Other OP (%BC): 41.82]","count":"264","median_amount":1482.93,"10th_percentile":805.62,"90th_percentile":4134.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [All OP services (%BC): 77.4] [OP Surgery  (%BC): 77.4] [Observation (%BC): 77.4] [Emergency Department (%BC): 77.4] [Occupational Therapy (%BC): 77.4] [Physical Therapy (%BC): 77.4] [Respiratory Services/Therapy  (%BC): 77.4] [Speech Therapy (%BC): 77.4] [All Other OP (%BC): 77.4]","count":"619","median_amount":1988.39,"10th_percentile":503.48,"90th_percentile":3836.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"49","median_amount":1467.4,"10th_percentile":801.92,"90th_percentile":4119.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41] [OP Surgery  (%BC): 41] [Observation (%BC): 41] [Emergency Department (%BC): 41] [Occupational Therapy (%BC): 41] [Physical Therapy (%BC): 41] [Respiratory Services/Therapy  (%BC): 41] [Speech Therapy (%BC): 41] [All Other OP (%BC): 41]","count":"159","median_amount":1532.87,"10th_percentile":758.95,"90th_percentile":4903.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 60.6] [OP Surgery  (%BC): 60.6] [Observation (%BC): 60.6] [Emergency Department (%BC): 60.6] [Occupational Therapy (%BC): 60.6] [Physical Therapy (%BC): 60.6] [Respiratory Services/Therapy  (%BC): 60.6] [Speech Therapy (%BC): 60.6] [All Other OP (%BC): 60.6]","count":"26","median_amount":2523.53,"10th_percentile":1638.25,"90th_percentile":4430.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Bluecard Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"36","median_amount":1699.23,"10th_percentile":845.62,"90th_percentile":4454.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [Emergency Department ($): 40]","count":"212","median_amount":768.23,"10th_percentile":201.5,"90th_percentile":1409.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"47","median_amount":777.68,"10th_percentile":276.41,"90th_percentile":1512.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 79.2] [OP Surgery  (%BC): 79.2] [Observation (%BC): 79.2] [Emergency Department (%BC): 79.2] [Occupational Therapy (%BC): 79.2] [Physical Therapy (%BC): 79.2] [Respiratory Services/Therapy  (%BC): 79.2] [Speech Therapy (%BC): 79.2] [All Other OP (%BC): 79.2]","count":"1 through 10","median_amount":2426.82,"10th_percentile":1092.12,"90th_percentile":3406.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":3781.41,"10th_percentile":3781.41,"90th_percentile":3781.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74] [Observation (%BC): 74] [Emergency Department (%BC): 74] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 74] [Physical Therapy (%BC): 74] [Respiratory Services/Therapy  (%BC): 74] [Speech Therapy (%BC): 74] [All Other OP (%BC): 74]","count":"1 through 10","median_amount":2499.37,"10th_percentile":1333.74,"90th_percentile":3341.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 78] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [All Other OP (%BC): 78]","count":"1 through 10","median_amount":876.66,"10th_percentile":876.66,"90th_percentile":876.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"73","median_amount":840.14,"10th_percentile":281.41,"90th_percentile":1529.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 39] [OP Surgery  (%BC): 39] [Observation (%BC): 39] [Emergency Department (%BC): 39] [Occupational Therapy (%BC): 39] [Physical Therapy (%BC): 39] [Respiratory Services/Therapy  (%BC): 39] [Speech Therapy (%BC): 39] [All Other OP (%BC): 39]","count":"120","median_amount":1210.25,"10th_percentile":219.46,"90th_percentile":4628.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"168","median_amount":2128.19,"10th_percentile":1089.35,"90th_percentile":4207.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"20","median_amount":796.56,"10th_percentile":159.51,"90th_percentile":1584.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"1 through 10","median_amount":1151.41,"10th_percentile":1151.41,"90th_percentile":1151.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"1 through 10","median_amount":2417.64,"10th_percentile":2417.64,"90th_percentile":2417.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 75] [OP Surgery  (%BC): 75] [Observation (%BC): 75] [Emergency Department (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [All Other OP (%BC): 75]","count":"152","median_amount":1726.2,"10th_percentile":758.89,"90th_percentile":4061.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72] [OP Surgery  (%BC): 72] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 72] [Physical Therapy (%BC): 72] [Respiratory Services/Therapy  (%BC): 72] [Speech Therapy (%BC): 72] [All Other OP (%BC): 72]","count":"1 through 10","median_amount":2294.02,"10th_percentile":2294.02,"90th_percentile":2294.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"1 through 10","median_amount":3572.21,"10th_percentile":3572.21,"90th_percentile":3572.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"48","median_amount":2573.58,"10th_percentile":1615.48,"90th_percentile":4152.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"55","median_amount":2697.36,"10th_percentile":1119.72,"90th_percentile":10133.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [ED Level 1--99281 ($): 27.09] [ED Level 2--99282 ($): 41.69] [ED Level 3--99283 ($): 73.69] [ED Level 4--99284 ($): 123.51] [ED Level 5--99285 ($): 223.93] [Clinic Visit ($): 59.34] [OP High Cost Drugs (%BC): 40] [Other Outpatient Implant (%BC): 40]","count":"59","median_amount":825.71,"10th_percentile":329.58,"90th_percentile":2078.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"106","median_amount":2554.0,"10th_percentile":1021.08,"90th_percentile":7719.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"1 through 10","median_amount":2494.58,"10th_percentile":2085.59,"90th_percentile":3847.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":1745.34,"10th_percentile":1441.06,"90th_percentile":5463.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 5 Type A ED Visits","code_information":[{"code":"5025","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 84] [OP Surgery  (%BC): 84] [Observation (%BC): 84] [Emergency Department (%BC): 84] [Occupational Therapy (%BC): 84] [Physical Therapy (%BC): 84] [Respiratory Services/Therapy  (%BC): 84] [Speech Therapy (%BC): 84] [All Other OP (%BC): 84]","count":"16","median_amount":5110.74,"10th_percentile":1363.84,"90th_percentile":10455.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"25","median_amount":2485.49,"10th_percentile":1545.32,"90th_percentile":6354.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41.82] [OP Surgery  (%BC): 41.82] [Observation (%BC): 41.82] [Emergency Department (%BC): 41.82] [Occupational Therapy (%BC): 41.82] [Physical Therapy (%BC): 41.82] [Respiratory Services/Therapy  (%BC): 41.82] [Speech Therapy (%BC): 41.82] [All Other OP (%BC): 41.82]","count":"130","median_amount":2409.59,"10th_percentile":1308.65,"90th_percentile":5135.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":2034.7,"10th_percentile":2034.7,"90th_percentile":2034.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [All OP services (%BC): 77.4] [OP Surgery  (%BC): 77.4] [Observation (%BC): 77.4] [Emergency Department (%BC): 77.4] [Occupational Therapy (%BC): 77.4] [Physical Therapy (%BC): 77.4] [Respiratory Services/Therapy  (%BC): 77.4] [Speech Therapy (%BC): 77.4] [All Other OP (%BC): 77.4]","count":"204","median_amount":4044.43,"10th_percentile":608.83,"90th_percentile":6558.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"22","median_amount":2296.72,"10th_percentile":1491.51,"90th_percentile":4431.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41] [OP Surgery  (%BC): 41] [Observation (%BC): 41] [Emergency Department (%BC): 41] [Occupational Therapy (%BC): 41] [Physical Therapy (%BC): 41] [Respiratory Services/Therapy  (%BC): 41] [Speech Therapy (%BC): 41] [All Other OP (%BC): 41]","count":"75","median_amount":2918.6,"10th_percentile":1430.02,"90th_percentile":5920.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 60.6] [OP Surgery  (%BC): 60.6] [Observation (%BC): 60.6] [Emergency Department (%BC): 60.6] [Occupational Therapy (%BC): 60.6] [Physical Therapy (%BC): 60.6] [Respiratory Services/Therapy  (%BC): 60.6] [Speech Therapy (%BC): 60.6] [All Other OP (%BC): 60.6]","count":"11","median_amount":4743.52,"10th_percentile":2471.45,"90th_percentile":7099.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Bluecard Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"12","median_amount":3266.45,"10th_percentile":2025.79,"90th_percentile":8204.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [Emergency Department ($): 40]","count":"88","median_amount":1209.27,"10th_percentile":332.6,"90th_percentile":2008.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"24","median_amount":858.55,"10th_percentile":209.96,"90th_percentile":1583.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 79.2] [OP Surgery  (%BC): 79.2] [Observation (%BC): 79.2] [Emergency Department (%BC): 79.2] [Occupational Therapy (%BC): 79.2] [Physical Therapy (%BC): 79.2] [Respiratory Services/Therapy  (%BC): 79.2] [Speech Therapy (%BC): 79.2] [All Other OP (%BC): 79.2]","count":"1 through 10","median_amount":4574.79,"10th_percentile":3320.42,"90th_percentile":8723.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":2241.08,"10th_percentile":2241.08,"90th_percentile":2241.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74] [Observation (%BC): 74] [Emergency Department (%BC): 74] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 74] [Physical Therapy (%BC): 74] [Respiratory Services/Therapy  (%BC): 74] [Speech Therapy (%BC): 74] [All Other OP (%BC): 74]","count":"1 through 10","median_amount":7660.53,"10th_percentile":5384.03,"90th_percentile":8214.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 78] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [All Other OP (%BC): 78]","count":"1 through 10","median_amount":7893.57,"10th_percentile":7893.57,"90th_percentile":7893.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"34","median_amount":1269.73,"10th_percentile":437.25,"90th_percentile":2215.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 39] [OP Surgery  (%BC): 39] [Observation (%BC): 39] [Emergency Department (%BC): 39] [Occupational Therapy (%BC): 39] [Physical Therapy (%BC): 39] [Respiratory Services/Therapy  (%BC): 39] [Speech Therapy (%BC): 39] [All Other OP (%BC): 39]","count":"75","median_amount":2836.87,"10th_percentile":1504.21,"90th_percentile":5694.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"85","median_amount":3952.58,"10th_percentile":1900.54,"90th_percentile":7225.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"14","median_amount":925.81,"10th_percentile":270.41,"90th_percentile":1554.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Mycare Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 75] [OP Surgery  (%BC): 75] [Observation (%BC): 75] [Emergency Department (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [All Other OP (%BC): 75]","count":"78","median_amount":2208.24,"10th_percentile":400.0,"90th_percentile":5788.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72] [OP Surgery  (%BC): 72] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 72] [Physical Therapy (%BC): 72] [Respiratory Services/Therapy  (%BC): 72] [Speech Therapy (%BC): 72] [All Other OP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"23","median_amount":4490.38,"10th_percentile":3441.8,"90th_percentile":9287.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"22","median_amount":3022.84,"10th_percentile":1711.65,"90th_percentile":7632.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [ED Level 1--99281 ($): 27.09] [ED Level 2--99282 ($): 41.69] [ED Level 3--99283 ($): 73.69] [ED Level 4--99284 ($): 123.51] [ED Level 5--99285 ($): 223.93] [Clinic Visit ($): 59.34] [OP High Cost Drugs (%BC): 40] [Other Outpatient Implant (%BC): 40]","count":"27","median_amount":1507.44,"10th_percentile":537.24,"90th_percentile":2105.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"61","median_amount":4043.56,"10th_percentile":1018.69,"90th_percentile":9117.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"1 through 10","median_amount":1693.28,"10th_percentile":527.98,"90th_percentile":3425.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":2926.07,"10th_percentile":1890.79,"90th_percentile":4863.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Critical Care","code_information":[{"code":"5041","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 84] [OP Surgery  (%BC): 84] [Observation (%BC): 84] [Emergency Department (%BC): 84] [Occupational Therapy (%BC): 84] [Physical Therapy (%BC): 84] [Respiratory Services/Therapy  (%BC): 84] [Speech Therapy (%BC): 84] [All Other OP (%BC): 84]","count":"1 through 10","median_amount":6866.24,"10th_percentile":6866.24,"90th_percentile":6866.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":4881.62,"10th_percentile":2922.39,"90th_percentile":9802.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41.82] [OP Surgery  (%BC): 41.82] [Observation (%BC): 41.82] [Emergency Department (%BC): 41.82] [Occupational Therapy (%BC): 41.82] [Physical Therapy (%BC): 41.82] [Respiratory Services/Therapy  (%BC): 41.82] [Speech Therapy (%BC): 41.82] [All Other OP (%BC): 41.82]","count":"26","median_amount":2610.9,"10th_percentile":1369.87,"90th_percentile":5404.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [All OP services (%BC): 77.4] [OP Surgery  (%BC): 77.4] [Observation (%BC): 77.4] [Emergency Department (%BC): 77.4] [Occupational Therapy (%BC): 77.4] [Physical Therapy (%BC): 77.4] [Respiratory Services/Therapy  (%BC): 77.4] [Speech Therapy (%BC): 77.4] [All Other OP (%BC): 77.4]","count":"28","median_amount":4823.57,"10th_percentile":1066.69,"90th_percentile":8287.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"1 through 10","median_amount":4760.04,"10th_percentile":3119.72,"90th_percentile":10626.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41] [OP Surgery  (%BC): 41] [Observation (%BC): 41] [Emergency Department (%BC): 41] [Occupational Therapy (%BC): 41] [Physical Therapy (%BC): 41] [Respiratory Services/Therapy  (%BC): 41] [Speech Therapy (%BC): 41] [All Other OP (%BC): 41]","count":"23","median_amount":2716.57,"10th_percentile":1453.07,"90th_percentile":4244.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 60.6] [OP Surgery  (%BC): 60.6] [Observation (%BC): 60.6] [Emergency Department (%BC): 60.6] [Occupational Therapy (%BC): 60.6] [Physical Therapy (%BC): 60.6] [Respiratory Services/Therapy  (%BC): 60.6] [Speech Therapy (%BC): 60.6] [All Other OP (%BC): 60.6]","count":"1 through 10","median_amount":7891.25,"10th_percentile":6689.35,"90th_percentile":8120.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Bluecard Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":2365.22,"10th_percentile":2365.22,"90th_percentile":3425.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [Emergency Department ($): 40]","count":"1 through 10","median_amount":1669.89,"10th_percentile":783.98,"90th_percentile":2744.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":2337.9,"10th_percentile":2337.9,"90th_percentile":2337.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 79.2] [OP Surgery  (%BC): 79.2] [Observation (%BC): 79.2] [Emergency Department (%BC): 79.2] [Occupational Therapy (%BC): 79.2] [Physical Therapy (%BC): 79.2] [Respiratory Services/Therapy  (%BC): 79.2] [Speech Therapy (%BC): 79.2] [All Other OP (%BC): 79.2]","count":"1 through 10","median_amount":8478.93,"10th_percentile":8478.93,"90th_percentile":8478.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74] [Observation (%BC): 74] [Emergency Department (%BC): 74] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 74] [Physical Therapy (%BC): 74] [Respiratory Services/Therapy  (%BC): 74] [Speech Therapy (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 78] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"1 through 10","median_amount":415.68,"10th_percentile":415.68,"90th_percentile":415.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 39] [OP Surgery  (%BC): 39] [Observation (%BC): 39] [Emergency Department (%BC): 39] [Occupational Therapy (%BC): 39] [Physical Therapy (%BC): 39] [Respiratory Services/Therapy  (%BC): 39] [Speech Therapy (%BC): 39] [All Other OP (%BC): 39]","count":"11","median_amount":3207.95,"10th_percentile":277.74,"90th_percentile":4462.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"1 through 10","median_amount":7662.84,"10th_percentile":7662.84,"90th_percentile":7662.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":1385.29,"10th_percentile":1366.33,"90th_percentile":1896.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Mycare Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 75] [OP Surgery  (%BC): 75] [Observation (%BC): 75] [Emergency Department (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [All Other OP (%BC): 75]","count":"12","median_amount":4699.77,"10th_percentile":893.87,"90th_percentile":8627.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72] [OP Surgery  (%BC): 72] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 72] [Physical Therapy (%BC): 72] [Respiratory Services/Therapy  (%BC): 72] [Speech Therapy (%BC): 72] [All Other OP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"1 through 10","median_amount":5129.48,"10th_percentile":4571.27,"90th_percentile":7080.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [ED Level 1--99281 ($): 27.09] [ED Level 2--99282 ($): 41.69] [ED Level 3--99283 ($): 73.69] [ED Level 4--99284 ($): 123.51] [ED Level 5--99285 ($): 223.93] [Clinic Visit ($): 59.34] [OP High Cost Drugs (%BC): 40] [Other Outpatient Implant (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"11","median_amount":4073.65,"10th_percentile":60.0,"90th_percentile":8093.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"1 through 10","median_amount":1350.73,"10th_percentile":1350.73,"90th_percentile":2788.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":2588.24,"10th_percentile":2588.24,"90th_percentile":2588.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 Skin Procedures","code_information":[{"code":"5051","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 84] [OP Surgery  (%BC): 84] [Observation (%BC): 84] [Emergency Department (%BC): 84] [Occupational Therapy (%BC): 84] [Physical Therapy (%BC): 84] [Respiratory Services/Therapy  (%BC): 84] [Speech Therapy (%BC): 84] [All Other OP (%BC): 84]","count":"1 through 10","median_amount":333.86,"10th_percentile":333.86,"90th_percentile":333.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":300.64,"10th_percentile":300.64,"90th_percentile":300.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41.82] [OP Surgery  (%BC): 41.82] [Observation (%BC): 41.82] [Emergency Department (%BC): 41.82] [Occupational Therapy (%BC): 41.82] [Physical Therapy (%BC): 41.82] [Respiratory Services/Therapy  (%BC): 41.82] [Speech Therapy (%BC): 41.82] [All Other OP (%BC): 41.82]","count":"15","median_amount":129.8,"10th_percentile":129.8,"90th_percentile":151.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [All OP services (%BC): 77.4] [OP Surgery  (%BC): 77.4] [Observation (%BC): 77.4] [Emergency Department (%BC): 77.4] [Occupational Therapy (%BC): 77.4] [Physical Therapy (%BC): 77.4] [Respiratory Services/Therapy  (%BC): 77.4] [Speech Therapy (%BC): 77.4] [All Other OP (%BC): 77.4]","count":"18","median_amount":316.6,"10th_percentile":262.72,"90th_percentile":652.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41] [OP Surgery  (%BC): 41] [Observation (%BC): 41] [Emergency Department (%BC): 41] [Occupational Therapy (%BC): 41] [Physical Therapy (%BC): 41] [Respiratory Services/Therapy  (%BC): 41] [Speech Therapy (%BC): 41] [All Other OP (%BC): 41]","count":"1 through 10","median_amount":146.2,"10th_percentile":125.41,"90th_percentile":162.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 60.6] [OP Surgery  (%BC): 60.6] [Observation (%BC): 60.6] [Emergency Department (%BC): 60.6] [Occupational Therapy (%BC): 60.6] [Physical Therapy (%BC): 60.6] [Respiratory Services/Therapy  (%BC): 60.6] [Speech Therapy (%BC): 60.6] [All Other OP (%BC): 60.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Bluecard Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":148.47,"10th_percentile":148.47,"90th_percentile":161.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [Emergency Department ($): 40]","count":"1 through 10","median_amount":49.21,"10th_percentile":49.21,"90th_percentile":289.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 79.2] [OP Surgery  (%BC): 79.2] [Observation (%BC): 79.2] [Emergency Department (%BC): 79.2] [Occupational Therapy (%BC): 79.2] [Physical Therapy (%BC): 79.2] [Respiratory Services/Therapy  (%BC): 79.2] [Speech Therapy (%BC): 79.2] [All Other OP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74] [Observation (%BC): 74] [Emergency Department (%BC): 74] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 74] [Physical Therapy (%BC): 74] [Respiratory Services/Therapy  (%BC): 74] [Speech Therapy (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 78] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"1 through 10","median_amount":38.6,"10th_percentile":38.6,"90th_percentile":38.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 39] [OP Surgery  (%BC): 39] [Observation (%BC): 39] [Emergency Department (%BC): 39] [Occupational Therapy (%BC): 39] [Physical Therapy (%BC): 39] [Respiratory Services/Therapy  (%BC): 39] [Speech Therapy (%BC): 39] [All Other OP (%BC): 39]","count":"1 through 10","median_amount":127.26,"10th_percentile":127.26,"90th_percentile":151.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"1 through 10","median_amount":539.78,"10th_percentile":294.93,"90th_percentile":6592.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Mycare Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 75] [OP Surgery  (%BC): 75] [Observation (%BC): 75] [Emergency Department (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [All Other OP (%BC): 75]","count":"1 through 10","median_amount":145.5,"10th_percentile":139.06,"90th_percentile":239.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72] [OP Surgery  (%BC): 72] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 72] [Physical Therapy (%BC): 72] [Respiratory Services/Therapy  (%BC): 72] [Speech Therapy (%BC): 72] [All Other OP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"1 through 10","median_amount":114.11,"10th_percentile":114.11,"90th_percentile":114.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [ED Level 1--99281 ($): 27.09] [ED Level 2--99282 ($): 41.69] [ED Level 3--99283 ($): 73.69] [ED Level 4--99284 ($): 123.51] [ED Level 5--99285 ($): 223.93] [Clinic Visit ($): 59.34] [OP High Cost Drugs (%BC): 40] [Other Outpatient Implant (%BC): 40]","count":"1 through 10","median_amount":262.72,"10th_percentile":262.72,"90th_percentile":262.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"12","median_amount":156.5,"10th_percentile":134.14,"90th_percentile":156.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"1 through 10","median_amount":118.24,"10th_percentile":118.24,"90th_percentile":118.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Skin Procedures","code_information":[{"code":"5052","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 84] [OP Surgery  (%BC): 84] [Observation (%BC): 84] [Emergency Department (%BC): 84] [Occupational Therapy (%BC): 84] [Physical Therapy (%BC): 84] [Respiratory Services/Therapy  (%BC): 84] [Speech Therapy (%BC): 84] [All Other OP (%BC): 84]","count":"13","median_amount":769.1,"10th_percentile":576.82,"90th_percentile":783.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"25","median_amount":528.58,"10th_percentile":336.56,"90th_percentile":598.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41.82] [OP Surgery  (%BC): 41.82] [Observation (%BC): 41.82] [Emergency Department (%BC): 41.82] [Occupational Therapy (%BC): 41.82] [Physical Therapy (%BC): 41.82] [Respiratory Services/Therapy  (%BC): 41.82] [Speech Therapy (%BC): 41.82] [All Other OP (%BC): 41.82]","count":"21","median_amount":348.87,"10th_percentile":33.17,"90th_percentile":576.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [All OP services (%BC): 77.4] [OP Surgery  (%BC): 77.4] [Observation (%BC): 77.4] [Emergency Department (%BC): 77.4] [Occupational Therapy (%BC): 77.4] [Physical Therapy (%BC): 77.4] [Respiratory Services/Therapy  (%BC): 77.4] [Speech Therapy (%BC): 77.4] [All Other OP (%BC): 77.4]","count":"53","median_amount":729.35,"10th_percentile":702.56,"90th_percentile":1217.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"1 through 10","median_amount":336.56,"10th_percentile":335.19,"90th_percentile":342.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41] [OP Surgery  (%BC): 41] [Observation (%BC): 41] [Emergency Department (%BC): 41] [Occupational Therapy (%BC): 41] [Physical Therapy (%BC): 41] [Respiratory Services/Therapy  (%BC): 41] [Speech Therapy (%BC): 41] [All Other OP (%BC): 41]","count":"38","median_amount":335.89,"10th_percentile":334.5,"90th_percentile":534.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 60.6] [OP Surgery  (%BC): 60.6] [Observation (%BC): 60.6] [Emergency Department (%BC): 60.6] [Occupational Therapy (%BC): 60.6] [Physical Therapy (%BC): 60.6] [Respiratory Services/Therapy  (%BC): 60.6] [Speech Therapy (%BC): 60.6] [All Other OP (%BC): 60.6]","count":"1 through 10","median_amount":581.97,"10th_percentile":571.28,"90th_percentile":894.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Bluecard Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [Emergency Department ($): 40]","count":"20","median_amount":372.21,"10th_percentile":83.39,"90th_percentile":372.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":359.75,"10th_percentile":359.75,"90th_percentile":372.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 79.2] [OP Surgery  (%BC): 79.2] [Observation (%BC): 79.2] [Emergency Department (%BC): 79.2] [Occupational Therapy (%BC): 79.2] [Physical Therapy (%BC): 79.2] [Respiratory Services/Therapy  (%BC): 79.2] [Speech Therapy (%BC): 79.2] [All Other OP (%BC): 79.2]","count":"26","median_amount":732.12,"10th_percentile":732.12,"90th_percentile":1235.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74] [Observation (%BC): 74] [Emergency Department (%BC): 74] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 74] [Physical Therapy (%BC): 74] [Respiratory Services/Therapy  (%BC): 74] [Speech Therapy (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 78] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"1 through 10","median_amount":73.96,"10th_percentile":73.96,"90th_percentile":73.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 39] [OP Surgery  (%BC): 39] [Observation (%BC): 39] [Emergency Department (%BC): 39] [Occupational Therapy (%BC): 39] [Physical Therapy (%BC): 39] [Respiratory Services/Therapy  (%BC): 39] [Speech Therapy (%BC): 39] [All Other OP (%BC): 39]","count":"17","median_amount":354.21,"10th_percentile":335.19,"90th_percentile":1209.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"27","median_amount":692.15,"10th_percentile":345.24,"90th_percentile":1383.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Mycare Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 75] [OP Surgery  (%BC): 75] [Observation (%BC): 75] [Emergency Department (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [All Other OP (%BC): 75]","count":"44","median_amount":335.19,"10th_percentile":319.5,"90th_percentile":771.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72] [OP Surgery  (%BC): 72] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 72] [Physical Therapy (%BC): 72] [Respiratory Services/Therapy  (%BC): 72] [Speech Therapy (%BC): 72] [All Other OP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"1 through 10","median_amount":786.87,"10th_percentile":786.87,"90th_percentile":845.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"1 through 10","median_amount":768.63,"10th_percentile":564.73,"90th_percentile":1326.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [ED Level 1--99281 ($): 27.09] [ED Level 2--99282 ($): 41.69] [ED Level 3--99283 ($): 73.69] [ED Level 4--99284 ($): 123.51] [ED Level 5--99285 ($): 223.93] [Clinic Visit ($): 59.34] [OP High Cost Drugs (%BC): 40] [Other Outpatient Implant (%BC): 40]","count":"1 through 10","median_amount":372.21,"10th_percentile":359.75,"90th_percentile":372.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"25","median_amount":788.48,"10th_percentile":360.52,"90th_percentile":1572.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"1 through 10","median_amount":324.04,"10th_percentile":324.04,"90th_percentile":324.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Skin Procedures","code_information":[{"code":"5053","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 84] [OP Surgery  (%BC): 84] [Observation (%BC): 84] [Emergency Department (%BC): 84] [Occupational Therapy (%BC): 84] [Physical Therapy (%BC): 84] [Respiratory Services/Therapy  (%BC): 84] [Speech Therapy (%BC): 84] [All Other OP (%BC): 84]","count":"1 through 10","median_amount":1177.54,"10th_percentile":1177.54,"90th_percentile":1177.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":3195.18,"10th_percentile":3195.18,"90th_percentile":3195.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41.82] [OP Surgery  (%BC): 41.82] [Observation (%BC): 41.82] [Emergency Department (%BC): 41.82] [Occupational Therapy (%BC): 41.82] [Physical Therapy (%BC): 41.82] [Respiratory Services/Therapy  (%BC): 41.82] [Speech Therapy (%BC): 41.82] [All Other OP (%BC): 41.82]","count":"1 through 10","median_amount":466.99,"10th_percentile":432.4,"90th_percentile":2715.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [All OP services (%BC): 77.4] [OP Surgery  (%BC): 77.4] [Observation (%BC): 77.4] [Emergency Department (%BC): 77.4] [Occupational Therapy (%BC): 77.4] [Physical Therapy (%BC): 77.4] [Respiratory Services/Therapy  (%BC): 77.4] [Speech Therapy (%BC): 77.4] [All Other OP (%BC): 77.4]","count":"1 through 10","median_amount":1289.07,"10th_percentile":942.73,"90th_percentile":16957.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41] [OP Surgery  (%BC): 41] [Observation (%BC): 41] [Emergency Department (%BC): 41] [Occupational Therapy (%BC): 41] [Physical Therapy (%BC): 41] [Respiratory Services/Therapy  (%BC): 41] [Speech Therapy (%BC): 41] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 60.6] [OP Surgery  (%BC): 60.6] [Observation (%BC): 60.6] [Emergency Department (%BC): 60.6] [Occupational Therapy (%BC): 60.6] [Physical Therapy (%BC): 60.6] [Respiratory Services/Therapy  (%BC): 60.6] [Speech Therapy (%BC): 60.6] [All Other OP (%BC): 60.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Bluecard Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [Emergency Department ($): 40]","count":"1 through 10","median_amount":372.21,"10th_percentile":372.21,"90th_percentile":558.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 79.2] [OP Surgery  (%BC): 79.2] [Observation (%BC): 79.2] [Emergency Department (%BC): 79.2] [Occupational Therapy (%BC): 79.2] [Physical Therapy (%BC): 79.2] [Respiratory Services/Therapy  (%BC): 79.2] [Speech Therapy (%BC): 79.2] [All Other OP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74] [Observation (%BC): 74] [Emergency Department (%BC): 74] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 74] [Physical Therapy (%BC): 74] [Respiratory Services/Therapy  (%BC): 74] [Speech Therapy (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 78] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 39] [OP Surgery  (%BC): 39] [Observation (%BC): 39] [Emergency Department (%BC): 39] [Occupational Therapy (%BC): 39] [Physical Therapy (%BC): 39] [Respiratory Services/Therapy  (%BC): 39] [Speech Therapy (%BC): 39] [All Other OP (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"1 through 10","median_amount":1793.13,"10th_percentile":1786.99,"90th_percentile":1847.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Mycare Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 75] [OP Surgery  (%BC): 75] [Observation (%BC): 75] [Emergency Department (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [All Other OP (%BC): 75]","count":"1 through 10","median_amount":5417.11,"10th_percentile":5417.11,"90th_percentile":5417.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72] [OP Surgery  (%BC): 72] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 72] [Physical Therapy (%BC): 72] [Respiratory Services/Therapy  (%BC): 72] [Speech Therapy (%BC): 72] [All Other OP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [ED Level 1--99281 ($): 27.09] [ED Level 2--99282 ($): 41.69] [ED Level 3--99283 ($): 73.69] [ED Level 4--99284 ($): 123.51] [ED Level 5--99285 ($): 223.93] [Clinic Visit ($): 59.34] [OP High Cost Drugs (%BC): 40] [Other Outpatient Implant (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Skin Procedures","code_information":[{"code":"5054","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 84] [OP Surgery  (%BC): 84] [Observation (%BC): 84] [Emergency Department (%BC): 84] [Occupational Therapy (%BC): 84] [Physical Therapy (%BC): 84] [Respiratory Services/Therapy  (%BC): 84] [Speech Therapy (%BC): 84] [All Other OP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":2303.63,"10th_percentile":2205.93,"90th_percentile":11800.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41.82] [OP Surgery  (%BC): 41.82] [Observation (%BC): 41.82] [Emergency Department (%BC): 41.82] [Occupational Therapy (%BC): 41.82] [Physical Therapy (%BC): 41.82] [Respiratory Services/Therapy  (%BC): 41.82] [Speech Therapy (%BC): 41.82] [All Other OP (%BC): 41.82]","count":"1 through 10","median_amount":3417.24,"10th_percentile":3417.24,"90th_percentile":3417.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [All OP services (%BC): 77.4] [OP Surgery  (%BC): 77.4] [Observation (%BC): 77.4] [Emergency Department (%BC): 77.4] [Occupational Therapy (%BC): 77.4] [Physical Therapy (%BC): 77.4] [Respiratory Services/Therapy  (%BC): 77.4] [Speech Therapy (%BC): 77.4] [All Other OP (%BC): 77.4]","count":"1 through 10","median_amount":1568.41,"10th_percentile":1568.41,"90th_percentile":1568.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"1 through 10","median_amount":2251.75,"10th_percentile":2251.75,"90th_percentile":2251.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41] [OP Surgery  (%BC): 41] [Observation (%BC): 41] [Emergency Department (%BC): 41] [Occupational Therapy (%BC): 41] [Physical Therapy (%BC): 41] [Respiratory Services/Therapy  (%BC): 41] [Speech Therapy (%BC): 41] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 60.6] [OP Surgery  (%BC): 60.6] [Observation (%BC): 60.6] [Emergency Department (%BC): 60.6] [Occupational Therapy (%BC): 60.6] [Physical Therapy (%BC): 60.6] [Respiratory Services/Therapy  (%BC): 60.6] [Speech Therapy (%BC): 60.6] [All Other OP (%BC): 60.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Bluecard Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [Emergency Department ($): 40]","count":"1 through 10","median_amount":2286.59,"10th_percentile":2286.59,"90th_percentile":2658.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":2210.09,"10th_percentile":2210.09,"90th_percentile":2210.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 79.2] [OP Surgery  (%BC): 79.2] [Observation (%BC): 79.2] [Emergency Department (%BC): 79.2] [Occupational Therapy (%BC): 79.2] [Physical Therapy (%BC): 79.2] [Respiratory Services/Therapy  (%BC): 79.2] [Speech Therapy (%BC): 79.2] [All Other OP (%BC): 79.2]","count":"1 through 10","median_amount":3745.48,"10th_percentile":3745.48,"90th_percentile":3752.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74] [Observation (%BC): 74] [Emergency Department (%BC): 74] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 74] [Physical Therapy (%BC): 74] [Respiratory Services/Therapy  (%BC): 74] [Speech Therapy (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 78] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 39] [OP Surgery  (%BC): 39] [Observation (%BC): 39] [Emergency Department (%BC): 39] [Occupational Therapy (%BC): 39] [Physical Therapy (%BC): 39] [Respiratory Services/Therapy  (%BC): 39] [Speech Therapy (%BC): 39] [All Other OP (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Mycare Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 75] [OP Surgery  (%BC): 75] [Observation (%BC): 75] [Emergency Department (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [All Other OP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72] [OP Surgery  (%BC): 72] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 72] [Physical Therapy (%BC): 72] [Respiratory Services/Therapy  (%BC): 72] [Speech Therapy (%BC): 72] [All Other OP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [ED Level 1--99281 ($): 27.09] [ED Level 2--99282 ($): 41.69] [ED Level 3--99283 ($): 73.69] [ED Level 4--99284 ($): 123.51] [ED Level 5--99285 ($): 223.93] [Clinic Visit ($): 59.34] [OP High Cost Drugs (%BC): 40] [Other Outpatient Implant (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":2943.27,"10th_percentile":2943.27,"90th_percentile":2943.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 5 Skin Procedures","code_information":[{"code":"5055","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 84] [OP Surgery  (%BC): 84] [Observation (%BC): 84] [Emergency Department (%BC): 84] [Occupational Therapy (%BC): 84] [Physical Therapy (%BC): 84] [Respiratory Services/Therapy  (%BC): 84] [Speech Therapy (%BC): 84] [All Other OP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41.82] [OP Surgery  (%BC): 41.82] [Observation (%BC): 41.82] [Emergency Department (%BC): 41.82] [Occupational Therapy (%BC): 41.82] [Physical Therapy (%BC): 41.82] [Respiratory Services/Therapy  (%BC): 41.82] [Speech Therapy (%BC): 41.82] [All Other OP (%BC): 41.82]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [All OP services (%BC): 77.4] [OP Surgery  (%BC): 77.4] [Observation (%BC): 77.4] [Emergency Department (%BC): 77.4] [Occupational Therapy (%BC): 77.4] [Physical Therapy (%BC): 77.4] [Respiratory Services/Therapy  (%BC): 77.4] [Speech Therapy (%BC): 77.4] [All Other OP (%BC): 77.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41] [OP Surgery  (%BC): 41] [Observation (%BC): 41] [Emergency Department (%BC): 41] [Occupational Therapy (%BC): 41] [Physical Therapy (%BC): 41] [Respiratory Services/Therapy  (%BC): 41] [Speech Therapy (%BC): 41] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 60.6] [OP Surgery  (%BC): 60.6] [Observation (%BC): 60.6] [Emergency Department (%BC): 60.6] [Occupational Therapy (%BC): 60.6] [Physical Therapy (%BC): 60.6] [Respiratory Services/Therapy  (%BC): 60.6] [Speech Therapy (%BC): 60.6] [All Other OP (%BC): 60.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Bluecard Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [Emergency Department ($): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 79.2] [OP Surgery  (%BC): 79.2] [Observation (%BC): 79.2] [Emergency Department (%BC): 79.2] [Occupational Therapy (%BC): 79.2] [Physical Therapy (%BC): 79.2] [Respiratory Services/Therapy  (%BC): 79.2] [Speech Therapy (%BC): 79.2] [All Other OP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74] [Observation (%BC): 74] [Emergency Department (%BC): 74] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 74] [Physical Therapy (%BC): 74] [Respiratory Services/Therapy  (%BC): 74] [Speech Therapy (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 78] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 39] [OP Surgery  (%BC): 39] [Observation (%BC): 39] [Emergency Department (%BC): 39] [Occupational Therapy (%BC): 39] [Physical Therapy (%BC): 39] [Respiratory Services/Therapy  (%BC): 39] [Speech Therapy (%BC): 39] [All Other OP (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Mycare Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 75] [OP Surgery  (%BC): 75] [Observation (%BC): 75] [Emergency Department (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [All Other OP (%BC): 75]","count":"1 through 10","median_amount":2999.46,"10th_percentile":2999.46,"90th_percentile":2999.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72] [OP Surgery  (%BC): 72] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 72] [Physical Therapy (%BC): 72] [Respiratory Services/Therapy  (%BC): 72] [Speech Therapy (%BC): 72] [All Other OP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [ED Level 1--99281 ($): 27.09] [ED Level 2--99282 ($): 41.69] [ED Level 3--99283 ($): 73.69] [ED Level 4--99284 ($): 123.51] [ED Level 5--99285 ($): 223.93] [Clinic Visit ($): 59.34] [OP High Cost Drugs (%BC): 40] [Other Outpatient Implant (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hyperbaric Oxygen","code_information":[{"code":"5061","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 84] [OP Surgery  (%BC): 84] [Observation (%BC): 84] [Emergency Department (%BC): 84] [Occupational Therapy (%BC): 84] [Physical Therapy (%BC): 84] [Respiratory Services/Therapy  (%BC): 84] [Speech Therapy (%BC): 84] [All Other OP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41.82] [OP Surgery  (%BC): 41.82] [Observation (%BC): 41.82] [Emergency Department (%BC): 41.82] [Occupational Therapy (%BC): 41.82] [Physical Therapy (%BC): 41.82] [Respiratory Services/Therapy  (%BC): 41.82] [Speech Therapy (%BC): 41.82] [All Other OP (%BC): 41.82]","count":"20","median_amount":933.3,"10th_percentile":933.3,"90th_percentile":933.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [All OP services (%BC): 77.4] [OP Surgery  (%BC): 77.4] [Observation (%BC): 77.4] [Emergency Department (%BC): 77.4] [Occupational Therapy (%BC): 77.4] [Physical Therapy (%BC): 77.4] [Respiratory Services/Therapy  (%BC): 77.4] [Speech Therapy (%BC): 77.4] [All Other OP (%BC): 77.4]","count":"104","median_amount":1951.17,"10th_percentile":1951.17,"90th_percentile":1951.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41] [OP Surgery  (%BC): 41] [Observation (%BC): 41] [Emergency Department (%BC): 41] [Occupational Therapy (%BC): 41] [Physical Therapy (%BC): 41] [Respiratory Services/Therapy  (%BC): 41] [Speech Therapy (%BC): 41] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 60.6] [OP Surgery  (%BC): 60.6] [Observation (%BC): 60.6] [Emergency Department (%BC): 60.6] [Occupational Therapy (%BC): 60.6] [Physical Therapy (%BC): 60.6] [Respiratory Services/Therapy  (%BC): 60.6] [Speech Therapy (%BC): 60.6] [All Other OP (%BC): 60.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Bluecard Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [Emergency Department ($): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 79.2] [OP Surgery  (%BC): 79.2] [Observation (%BC): 79.2] [Emergency Department (%BC): 79.2] [Occupational Therapy (%BC): 79.2] [Physical Therapy (%BC): 79.2] [Respiratory Services/Therapy  (%BC): 79.2] [Speech Therapy (%BC): 79.2] [All Other OP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74] [Observation (%BC): 74] [Emergency Department (%BC): 74] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 74] [Physical Therapy (%BC): 74] [Respiratory Services/Therapy  (%BC): 74] [Speech Therapy (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 78] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 39] [OP Surgery  (%BC): 39] [Observation (%BC): 39] [Emergency Department (%BC): 39] [Occupational Therapy (%BC): 39] [Physical Therapy (%BC): 39] [Respiratory Services/Therapy  (%BC): 39] [Speech Therapy (%BC): 39] [All Other OP (%BC): 39]","count":"1 through 10","median_amount":898.8,"10th_percentile":898.8,"90th_percentile":971.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"17","median_amount":923.8,"10th_percentile":923.8,"90th_percentile":923.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Mycare Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 75] [OP Surgery  (%BC): 75] [Observation (%BC): 75] [Emergency Department (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [All Other OP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72] [OP Surgery  (%BC): 72] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 72] [Physical Therapy (%BC): 72] [Respiratory Services/Therapy  (%BC): 72] [Speech Therapy (%BC): 72] [All Other OP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [ED Level 1--99281 ($): 27.09] [ED Level 2--99282 ($): 41.69] [ED Level 3--99283 ($): 73.69] [ED Level 4--99284 ($): 123.51] [ED Level 5--99285 ($): 223.93] [Clinic Visit ($): 59.34] [OP High Cost Drugs (%BC): 40] [Other Outpatient Implant (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Excision/ Biopsy/ Incision and Drainage","code_information":[{"code":"5071","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 84] [OP Surgery  (%BC): 84] [Observation (%BC): 84] [Emergency Department (%BC): 84] [Occupational Therapy (%BC): 84] [Physical Therapy (%BC): 84] [Respiratory Services/Therapy  (%BC): 84] [Speech Therapy (%BC): 84] [All Other OP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41.82] [OP Surgery  (%BC): 41.82] [Observation (%BC): 41.82] [Emergency Department (%BC): 41.82] [Occupational Therapy (%BC): 41.82] [Physical Therapy (%BC): 41.82] [Respiratory Services/Therapy  (%BC): 41.82] [Speech Therapy (%BC): 41.82] [All Other OP (%BC): 41.82]","count":"1 through 10","median_amount":660.89,"10th_percentile":660.89,"90th_percentile":660.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [All OP services (%BC): 77.4] [OP Surgery  (%BC): 77.4] [Observation (%BC): 77.4] [Emergency Department (%BC): 77.4] [Occupational Therapy (%BC): 77.4] [Physical Therapy (%BC): 77.4] [Respiratory Services/Therapy  (%BC): 77.4] [Speech Therapy (%BC): 77.4] [All Other OP (%BC): 77.4]","count":"11","median_amount":1310.79,"10th_percentile":606.03,"90th_percentile":5920.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"1 through 10","median_amount":872.74,"10th_percentile":872.74,"90th_percentile":872.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41] [OP Surgery  (%BC): 41] [Observation (%BC): 41] [Emergency Department (%BC): 41] [Occupational Therapy (%BC): 41] [Physical Therapy (%BC): 41] [Respiratory Services/Therapy  (%BC): 41] [Speech Therapy (%BC): 41] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 60.6] [OP Surgery  (%BC): 60.6] [Observation (%BC): 60.6] [Emergency Department (%BC): 60.6] [Occupational Therapy (%BC): 60.6] [Physical Therapy (%BC): 60.6] [Respiratory Services/Therapy  (%BC): 60.6] [Speech Therapy (%BC): 60.6] [All Other OP (%BC): 60.6]","count":"1 through 10","median_amount":1129.31,"10th_percentile":1129.31,"90th_percentile":1129.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Bluecard Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [Emergency Department ($): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":606.03,"10th_percentile":606.03,"90th_percentile":606.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 79.2] [OP Surgery  (%BC): 79.2] [Observation (%BC): 79.2] [Emergency Department (%BC): 79.2] [Occupational Therapy (%BC): 79.2] [Physical Therapy (%BC): 79.2] [Respiratory Services/Therapy  (%BC): 79.2] [Speech Therapy (%BC): 79.2] [All Other OP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74] [Observation (%BC): 74] [Emergency Department (%BC): 74] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 74] [Physical Therapy (%BC): 74] [Respiratory Services/Therapy  (%BC): 74] [Speech Therapy (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 78] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 39] [OP Surgery  (%BC): 39] [Observation (%BC): 39] [Emergency Department (%BC): 39] [Occupational Therapy (%BC): 39] [Physical Therapy (%BC): 39] [Respiratory Services/Therapy  (%BC): 39] [Speech Therapy (%BC): 39] [All Other OP (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"1 through 10","median_amount":2058.27,"10th_percentile":1221.09,"90th_percentile":3699.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":815.89,"10th_percentile":815.89,"90th_percentile":815.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Mycare Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 75] [OP Surgery  (%BC): 75] [Observation (%BC): 75] [Emergency Department (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [All Other OP (%BC): 75]","count":"1 through 10","median_amount":2490.4,"10th_percentile":2490.4,"90th_percentile":2490.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72] [OP Surgery  (%BC): 72] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 72] [Physical Therapy (%BC): 72] [Respiratory Services/Therapy  (%BC): 72] [Speech Therapy (%BC): 72] [All Other OP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"1 through 10","median_amount":1433.74,"10th_percentile":1433.74,"90th_percentile":1433.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [ED Level 1--99281 ($): 27.09] [ED Level 2--99282 ($): 41.69] [ED Level 3--99283 ($): 73.69] [ED Level 4--99284 ($): 123.51] [ED Level 5--99285 ($): 223.93] [Clinic Visit ($): 59.34] [OP High Cost Drugs (%BC): 40] [Other Outpatient Implant (%BC): 40]","count":"1 through 10","median_amount":598.77,"10th_percentile":598.77,"90th_percentile":598.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"1 through 10","median_amount":1268.62,"10th_percentile":1268.62,"90th_percentile":1268.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Excision/ Biopsy/ Incision and Drainage","code_information":[{"code":"5072","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 84] [OP Surgery  (%BC): 84] [Observation (%BC): 84] [Emergency Department (%BC): 84] [Occupational Therapy (%BC): 84] [Physical Therapy (%BC): 84] [Respiratory Services/Therapy  (%BC): 84] [Speech Therapy (%BC): 84] [All Other OP (%BC): 84]","count":"1 through 10","median_amount":4187.4,"10th_percentile":4187.4,"90th_percentile":4187.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":2020.14,"10th_percentile":2020.14,"90th_percentile":2825.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41.82] [OP Surgery  (%BC): 41.82] [Observation (%BC): 41.82] [Emergency Department (%BC): 41.82] [Occupational Therapy (%BC): 41.82] [Physical Therapy (%BC): 41.82] [Respiratory Services/Therapy  (%BC): 41.82] [Speech Therapy (%BC): 41.82] [All Other OP (%BC): 41.82]","count":"13","median_amount":1226.68,"10th_percentile":1001.81,"90th_percentile":1473.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [All OP services (%BC): 77.4] [OP Surgery  (%BC): 77.4] [Observation (%BC): 77.4] [Emergency Department (%BC): 77.4] [Occupational Therapy (%BC): 77.4] [Physical Therapy (%BC): 77.4] [Respiratory Services/Therapy  (%BC): 77.4] [Speech Therapy (%BC): 77.4] [All Other OP (%BC): 77.4]","count":"17","median_amount":3724.3,"10th_percentile":1605.96,"90th_percentile":10523.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41] [OP Surgery  (%BC): 41] [Observation (%BC): 41] [Emergency Department (%BC): 41] [Occupational Therapy (%BC): 41] [Physical Therapy (%BC): 41] [Respiratory Services/Therapy  (%BC): 41] [Speech Therapy (%BC): 41] [All Other OP (%BC): 41]","count":"1 through 10","median_amount":1862.35,"10th_percentile":1043.69,"90th_percentile":8214.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 60.6] [OP Surgery  (%BC): 60.6] [Observation (%BC): 60.6] [Emergency Department (%BC): 60.6] [Occupational Therapy (%BC): 60.6] [Physical Therapy (%BC): 60.6] [Respiratory Services/Therapy  (%BC): 60.6] [Speech Therapy (%BC): 60.6] [All Other OP (%BC): 60.6]","count":"1 through 10","median_amount":3973.2,"10th_percentile":3973.2,"90th_percentile":3973.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Bluecard Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":4332.76,"10th_percentile":4332.76,"90th_percentile":4332.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [Emergency Department ($): 40]","count":"1 through 10","median_amount":1489.56,"10th_percentile":1489.56,"90th_percentile":1733.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 79.2] [OP Surgery  (%BC): 79.2] [Observation (%BC): 79.2] [Emergency Department (%BC): 79.2] [Occupational Therapy (%BC): 79.2] [Physical Therapy (%BC): 79.2] [Respiratory Services/Therapy  (%BC): 79.2] [Speech Therapy (%BC): 79.2] [All Other OP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74] [Observation (%BC): 74] [Emergency Department (%BC): 74] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 74] [Physical Therapy (%BC): 74] [Respiratory Services/Therapy  (%BC): 74] [Speech Therapy (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 78] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"1 through 10","median_amount":2310.73,"10th_percentile":2310.73,"90th_percentile":2310.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 39] [OP Surgery  (%BC): 39] [Observation (%BC): 39] [Emergency Department (%BC): 39] [Occupational Therapy (%BC): 39] [Physical Therapy (%BC): 39] [Respiratory Services/Therapy  (%BC): 39] [Speech Therapy (%BC): 39] [All Other OP (%BC): 39]","count":"1 through 10","median_amount":880.17,"10th_percentile":107.42,"90th_percentile":3953.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"1 through 10","median_amount":3001.63,"10th_percentile":2173.65,"90th_percentile":4453.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Mycare Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 75] [OP Surgery  (%BC): 75] [Observation (%BC): 75] [Emergency Department (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [All Other OP (%BC): 75]","count":"1 through 10","median_amount":1811.39,"10th_percentile":1244.28,"90th_percentile":2468.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72] [OP Surgery  (%BC): 72] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 72] [Physical Therapy (%BC): 72] [Respiratory Services/Therapy  (%BC): 72] [Speech Therapy (%BC): 72] [All Other OP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"1 through 10","median_amount":7255.37,"10th_percentile":7255.37,"90th_percentile":7255.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [ED Level 1--99281 ($): 27.09] [ED Level 2--99282 ($): 41.69] [ED Level 3--99283 ($): 73.69] [ED Level 4--99284 ($): 123.51] [ED Level 5--99285 ($): 223.93] [Clinic Visit ($): 59.34] [OP High Cost Drugs (%BC): 40] [Other Outpatient Implant (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"1 through 10","median_amount":1279.28,"10th_percentile":1279.28,"90th_percentile":1279.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"1 through 10","median_amount":1935.41,"10th_percentile":1935.41,"90th_percentile":1935.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":2541.71,"10th_percentile":2541.71,"90th_percentile":2541.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Excision/ Biopsy/ Incision and Drainage","code_information":[{"code":"5073","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 84] [OP Surgery  (%BC): 84] [Observation (%BC): 84] [Emergency Department (%BC): 84] [Occupational Therapy (%BC): 84] [Physical Therapy (%BC): 84] [Respiratory Services/Therapy  (%BC): 84] [Speech Therapy (%BC): 84] [All Other OP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41.82] [OP Surgery  (%BC): 41.82] [Observation (%BC): 41.82] [Emergency Department (%BC): 41.82] [Occupational Therapy (%BC): 41.82] [Physical Therapy (%BC): 41.82] [Respiratory Services/Therapy  (%BC): 41.82] [Speech Therapy (%BC): 41.82] [All Other OP (%BC): 41.82]","count":"1 through 10","median_amount":2647.12,"10th_percentile":2542.62,"90th_percentile":7860.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [All OP services (%BC): 77.4] [OP Surgery  (%BC): 77.4] [Observation (%BC): 77.4] [Emergency Department (%BC): 77.4] [Occupational Therapy (%BC): 77.4] [Physical Therapy (%BC): 77.4] [Respiratory Services/Therapy  (%BC): 77.4] [Speech Therapy (%BC): 77.4] [All Other OP (%BC): 77.4]","count":"1 through 10","median_amount":4594.45,"10th_percentile":4594.45,"90th_percentile":10246.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41] [OP Surgery  (%BC): 41] [Observation (%BC): 41] [Emergency Department (%BC): 41] [Occupational Therapy (%BC): 41] [Physical Therapy (%BC): 41] [Respiratory Services/Therapy  (%BC): 41] [Speech Therapy (%BC): 41] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 60.6] [OP Surgery  (%BC): 60.6] [Observation (%BC): 60.6] [Emergency Department (%BC): 60.6] [Occupational Therapy (%BC): 60.6] [Physical Therapy (%BC): 60.6] [Respiratory Services/Therapy  (%BC): 60.6] [Speech Therapy (%BC): 60.6] [All Other OP (%BC): 60.6]","count":"1 through 10","median_amount":6419.78,"10th_percentile":6419.78,"90th_percentile":6419.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Bluecard Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [Emergency Department ($): 40]","count":"1 through 10","median_amount":2485.46,"10th_percentile":2485.46,"90th_percentile":2485.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 79.2] [OP Surgery  (%BC): 79.2] [Observation (%BC): 79.2] [Emergency Department (%BC): 79.2] [Occupational Therapy (%BC): 79.2] [Physical Therapy (%BC): 79.2] [Respiratory Services/Therapy  (%BC): 79.2] [Speech Therapy (%BC): 79.2] [All Other OP (%BC): 79.2]","count":"1 through 10","median_amount":6189.79,"10th_percentile":6189.79,"90th_percentile":6189.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74] [Observation (%BC): 74] [Emergency Department (%BC): 74] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 74] [Physical Therapy (%BC): 74] [Respiratory Services/Therapy  (%BC): 74] [Speech Therapy (%BC): 74] [All Other OP (%BC): 74]","count":"1 through 10","median_amount":6233.53,"10th_percentile":6233.53,"90th_percentile":6233.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 78] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"1 through 10","median_amount":914.6,"10th_percentile":914.6,"90th_percentile":3172.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 39] [OP Surgery  (%BC): 39] [Observation (%BC): 39] [Emergency Department (%BC): 39] [Occupational Therapy (%BC): 39] [Physical Therapy (%BC): 39] [Respiratory Services/Therapy  (%BC): 39] [Speech Therapy (%BC): 39] [All Other OP (%BC): 39]","count":"1 through 10","median_amount":2359.92,"10th_percentile":2359.92,"90th_percentile":2359.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"1 through 10","median_amount":12141.11,"10th_percentile":7347.45,"90th_percentile":18050.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Mycare Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 75] [OP Surgery  (%BC): 75] [Observation (%BC): 75] [Emergency Department (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [All Other OP (%BC): 75]","count":"1 through 10","median_amount":6071.93,"10th_percentile":6071.93,"90th_percentile":6071.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72] [OP Surgery  (%BC): 72] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 72] [Physical Therapy (%BC): 72] [Respiratory Services/Therapy  (%BC): 72] [Speech Therapy (%BC): 72] [All Other OP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"1 through 10","median_amount":5769.7,"10th_percentile":5769.7,"90th_percentile":5769.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"1 through 10","median_amount":615.91,"10th_percentile":615.91,"90th_percentile":615.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [ED Level 1--99281 ($): 27.09] [ED Level 2--99282 ($): 41.69] [ED Level 3--99283 ($): 73.69] [ED Level 4--99284 ($): 123.51] [ED Level 5--99285 ($): 223.93] [Clinic Visit ($): 59.34] [OP High Cost Drugs (%BC): 40] [Other Outpatient Implant (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"1 through 10","median_amount":7151.07,"10th_percentile":7151.07,"90th_percentile":7151.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Breast/Lymphatic Surgery and Related Procedures","code_information":[{"code":"5091","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 84] [OP Surgery  (%BC): 84] [Observation (%BC): 84] [Emergency Department (%BC): 84] [Occupational Therapy (%BC): 84] [Physical Therapy (%BC): 84] [Respiratory Services/Therapy  (%BC): 84] [Speech Therapy (%BC): 84] [All Other OP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41.82] [OP Surgery  (%BC): 41.82] [Observation (%BC): 41.82] [Emergency Department (%BC): 41.82] [Occupational Therapy (%BC): 41.82] [Physical Therapy (%BC): 41.82] [Respiratory Services/Therapy  (%BC): 41.82] [Speech Therapy (%BC): 41.82] [All Other OP (%BC): 41.82]","count":"1 through 10","median_amount":139.18,"10th_percentile":139.18,"90th_percentile":139.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [All OP services (%BC): 77.4] [OP Surgery  (%BC): 77.4] [Observation (%BC): 77.4] [Emergency Department (%BC): 77.4] [Occupational Therapy (%BC): 77.4] [Physical Therapy (%BC): 77.4] [Respiratory Services/Therapy  (%BC): 77.4] [Speech Therapy (%BC): 77.4] [All Other OP (%BC): 77.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41] [OP Surgery  (%BC): 41] [Observation (%BC): 41] [Emergency Department (%BC): 41] [Occupational Therapy (%BC): 41] [Physical Therapy (%BC): 41] [Respiratory Services/Therapy  (%BC): 41] [Speech Therapy (%BC): 41] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 60.6] [OP Surgery  (%BC): 60.6] [Observation (%BC): 60.6] [Emergency Department (%BC): 60.6] [Occupational Therapy (%BC): 60.6] [Physical Therapy (%BC): 60.6] [Respiratory Services/Therapy  (%BC): 60.6] [Speech Therapy (%BC): 60.6] [All Other OP (%BC): 60.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Bluecard Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [Emergency Department ($): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 79.2] [OP Surgery  (%BC): 79.2] [Observation (%BC): 79.2] [Emergency Department (%BC): 79.2] [Occupational Therapy (%BC): 79.2] [Physical Therapy (%BC): 79.2] [Respiratory Services/Therapy  (%BC): 79.2] [Speech Therapy (%BC): 79.2] [All Other OP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74] [Observation (%BC): 74] [Emergency Department (%BC): 74] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 74] [Physical Therapy (%BC): 74] [Respiratory Services/Therapy  (%BC): 74] [Speech Therapy (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 78] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 39] [OP Surgery  (%BC): 39] [Observation (%BC): 39] [Emergency Department (%BC): 39] [Occupational Therapy (%BC): 39] [Physical Therapy (%BC): 39] [Respiratory Services/Therapy  (%BC): 39] [Speech Therapy (%BC): 39] [All Other OP (%BC): 39]","count":"1 through 10","median_amount":8410.88,"10th_percentile":8410.88,"90th_percentile":8410.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"1 through 10","median_amount":3181.98,"10th_percentile":3181.98,"90th_percentile":3181.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Mycare Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 75] [OP Surgery  (%BC): 75] [Observation (%BC): 75] [Emergency Department (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [All Other OP (%BC): 75]","count":"1 through 10","median_amount":7609.8,"10th_percentile":7609.8,"90th_percentile":7609.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72] [OP Surgery  (%BC): 72] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 72] [Physical Therapy (%BC): 72] [Respiratory Services/Therapy  (%BC): 72] [Speech Therapy (%BC): 72] [All Other OP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [ED Level 1--99281 ($): 27.09] [ED Level 2--99282 ($): 41.69] [ED Level 3--99283 ($): 73.69] [ED Level 4--99284 ($): 123.51] [ED Level 5--99285 ($): 223.93] [Clinic Visit ($): 59.34] [OP High Cost Drugs (%BC): 40] [Other Outpatient Implant (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Breast/Lymphatic Surgery and Related Procedures","code_information":[{"code":"5092","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 84] [OP Surgery  (%BC): 84] [Observation (%BC): 84] [Emergency Department (%BC): 84] [Occupational Therapy (%BC): 84] [Physical Therapy (%BC): 84] [Respiratory Services/Therapy  (%BC): 84] [Speech Therapy (%BC): 84] [All Other OP (%BC): 84]","count":"1 through 10","median_amount":5141.58,"10th_percentile":5141.58,"90th_percentile":5141.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41.82] [OP Surgery  (%BC): 41.82] [Observation (%BC): 41.82] [Emergency Department (%BC): 41.82] [Occupational Therapy (%BC): 41.82] [Physical Therapy (%BC): 41.82] [Respiratory Services/Therapy  (%BC): 41.82] [Speech Therapy (%BC): 41.82] [All Other OP (%BC): 41.82]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [All OP services (%BC): 77.4] [OP Surgery  (%BC): 77.4] [Observation (%BC): 77.4] [Emergency Department (%BC): 77.4] [Occupational Therapy (%BC): 77.4] [Physical Therapy (%BC): 77.4] [Respiratory Services/Therapy  (%BC): 77.4] [Speech Therapy (%BC): 77.4] [All Other OP (%BC): 77.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41] [OP Surgery  (%BC): 41] [Observation (%BC): 41] [Emergency Department (%BC): 41] [Occupational Therapy (%BC): 41] [Physical Therapy (%BC): 41] [Respiratory Services/Therapy  (%BC): 41] [Speech Therapy (%BC): 41] [All Other OP (%BC): 41]","count":"1 through 10","median_amount":11874.82,"10th_percentile":11874.82,"90th_percentile":11874.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 60.6] [OP Surgery  (%BC): 60.6] [Observation (%BC): 60.6] [Emergency Department (%BC): 60.6] [Occupational Therapy (%BC): 60.6] [Physical Therapy (%BC): 60.6] [Respiratory Services/Therapy  (%BC): 60.6] [Speech Therapy (%BC): 60.6] [All Other OP (%BC): 60.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Bluecard Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":9168.73,"10th_percentile":9168.73,"90th_percentile":9168.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [Emergency Department ($): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 79.2] [OP Surgery  (%BC): 79.2] [Observation (%BC): 79.2] [Emergency Department (%BC): 79.2] [Occupational Therapy (%BC): 79.2] [Physical Therapy (%BC): 79.2] [Respiratory Services/Therapy  (%BC): 79.2] [Speech Therapy (%BC): 79.2] [All Other OP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74] [Observation (%BC): 74] [Emergency Department (%BC): 74] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 74] [Physical Therapy (%BC): 74] [Respiratory Services/Therapy  (%BC): 74] [Speech Therapy (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 78] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 39] [OP Surgery  (%BC): 39] [Observation (%BC): 39] [Emergency Department (%BC): 39] [Occupational Therapy (%BC): 39] [Physical Therapy (%BC): 39] [Respiratory Services/Therapy  (%BC): 39] [Speech Therapy (%BC): 39] [All Other OP (%BC): 39]","count":"1 through 10","median_amount":7023.88,"10th_percentile":7023.88,"90th_percentile":7023.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Mycare Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 75] [OP Surgery  (%BC): 75] [Observation (%BC): 75] [Emergency Department (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [All Other OP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72] [OP Surgery  (%BC): 72] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 72] [Physical Therapy (%BC): 72] [Respiratory Services/Therapy  (%BC): 72] [Speech Therapy (%BC): 72] [All Other OP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [ED Level 1--99281 ($): 27.09] [ED Level 2--99282 ($): 41.69] [ED Level 3--99283 ($): 73.69] [ED Level 4--99284 ($): 123.51] [ED Level 5--99285 ($): 223.93] [Clinic Visit ($): 59.34] [OP High Cost Drugs (%BC): 40] [Other Outpatient Implant (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Strapping and Cast Application","code_information":[{"code":"5101","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 84] [OP Surgery  (%BC): 84] [Observation (%BC): 84] [Emergency Department (%BC): 84] [Occupational Therapy (%BC): 84] [Physical Therapy (%BC): 84] [Respiratory Services/Therapy  (%BC): 84] [Speech Therapy (%BC): 84] [All Other OP (%BC): 84]","count":"1 through 10","median_amount":190.78,"10th_percentile":190.78,"90th_percentile":190.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":227.61,"10th_percentile":96.24,"90th_percentile":252.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41.82] [OP Surgery  (%BC): 41.82] [Observation (%BC): 41.82] [Emergency Department (%BC): 41.82] [Occupational Therapy (%BC): 41.82] [Physical Therapy (%BC): 41.82] [Respiratory Services/Therapy  (%BC): 41.82] [Speech Therapy (%BC): 41.82] [All Other OP (%BC): 41.82]","count":"1 through 10","median_amount":129.8,"10th_percentile":92.83,"90th_percentile":154.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [All OP services (%BC): 77.4] [OP Surgery  (%BC): 77.4] [Observation (%BC): 77.4] [Emergency Department (%BC): 77.4] [Occupational Therapy (%BC): 77.4] [Physical Therapy (%BC): 77.4] [Respiratory Services/Therapy  (%BC): 77.4] [Speech Therapy (%BC): 77.4] [All Other OP (%BC): 77.4]","count":"76","median_amount":293.99,"10th_percentile":180.92,"90th_percentile":542.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"50","median_amount":83.64,"10th_percentile":83.64,"90th_percentile":135.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41] [OP Surgery  (%BC): 41] [Observation (%BC): 41] [Emergency Department (%BC): 41] [Occupational Therapy (%BC): 41] [Physical Therapy (%BC): 41] [Respiratory Services/Therapy  (%BC): 41] [Speech Therapy (%BC): 41] [All Other OP (%BC): 41]","count":"16","median_amount":125.51,"10th_percentile":83.84,"90th_percentile":147.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 60.6] [OP Surgery  (%BC): 60.6] [Observation (%BC): 60.6] [Emergency Department (%BC): 60.6] [Occupational Therapy (%BC): 60.6] [Physical Therapy (%BC): 60.6] [Respiratory Services/Therapy  (%BC): 60.6] [Speech Therapy (%BC): 60.6] [All Other OP (%BC): 60.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Bluecard Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":150.24,"10th_percentile":150.24,"90th_percentile":150.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [Emergency Department ($): 40]","count":"55","median_amount":163.9,"10th_percentile":158.41,"90th_percentile":163.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 79.2] [OP Surgery  (%BC): 79.2] [Observation (%BC): 79.2] [Emergency Department (%BC): 79.2] [Occupational Therapy (%BC): 79.2] [Physical Therapy (%BC): 79.2] [Respiratory Services/Therapy  (%BC): 79.2] [Speech Therapy (%BC): 79.2] [All Other OP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74] [Observation (%BC): 74] [Emergency Department (%BC): 74] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 74] [Physical Therapy (%BC): 74] [Respiratory Services/Therapy  (%BC): 74] [Speech Therapy (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 78] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 39] [OP Surgery  (%BC): 39] [Observation (%BC): 39] [Emergency Department (%BC): 39] [Occupational Therapy (%BC): 39] [Physical Therapy (%BC): 39] [Respiratory Services/Therapy  (%BC): 39] [Speech Therapy (%BC): 39] [All Other OP (%BC): 39]","count":"17","median_amount":83.14,"10th_percentile":83.14,"90th_percentile":83.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Mycare Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 75] [OP Surgery  (%BC): 75] [Observation (%BC): 75] [Emergency Department (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [All Other OP (%BC): 75]","count":"1 through 10","median_amount":87.64,"10th_percentile":87.64,"90th_percentile":87.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72] [OP Surgery  (%BC): 72] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 72] [Physical Therapy (%BC): 72] [Respiratory Services/Therapy  (%BC): 72] [Speech Therapy (%BC): 72] [All Other OP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"1 through 10","median_amount":212.26,"10th_percentile":212.26,"90th_percentile":212.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"11","median_amount":347.59,"10th_percentile":201.78,"90th_percentile":406.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [ED Level 1--99281 ($): 27.09] [ED Level 2--99282 ($): 41.69] [ED Level 3--99283 ($): 73.69] [ED Level 4--99284 ($): 123.51] [ED Level 5--99285 ($): 223.93] [Clinic Visit ($): 59.34] [OP High Cost Drugs (%BC): 40] [Other Outpatient Implant (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"1 through 10","median_amount":89.43,"10th_percentile":89.43,"90th_percentile":134.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":87.64,"10th_percentile":87.64,"90th_percentile":87.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Strapping and Cast Application","code_information":[{"code":"5102","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 84] [OP Surgery  (%BC): 84] [Observation (%BC): 84] [Emergency Department (%BC): 84] [Occupational Therapy (%BC): 84] [Physical Therapy (%BC): 84] [Respiratory Services/Therapy  (%BC): 84] [Speech Therapy (%BC): 84] [All Other OP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41.82] [OP Surgery  (%BC): 41.82] [Observation (%BC): 41.82] [Emergency Department (%BC): 41.82] [Occupational Therapy (%BC): 41.82] [Physical Therapy (%BC): 41.82] [Respiratory Services/Therapy  (%BC): 41.82] [Speech Therapy (%BC): 41.82] [All Other OP (%BC): 41.82]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [All OP services (%BC): 77.4] [OP Surgery  (%BC): 77.4] [Observation (%BC): 77.4] [Emergency Department (%BC): 77.4] [Occupational Therapy (%BC): 77.4] [Physical Therapy (%BC): 77.4] [Respiratory Services/Therapy  (%BC): 77.4] [Speech Therapy (%BC): 77.4] [All Other OP (%BC): 77.4]","count":"1 through 10","median_amount":501.72,"10th_percentile":392.98,"90th_percentile":501.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41] [OP Surgery  (%BC): 41] [Observation (%BC): 41] [Emergency Department (%BC): 41] [Occupational Therapy (%BC): 41] [Physical Therapy (%BC): 41] [Respiratory Services/Therapy  (%BC): 41] [Speech Therapy (%BC): 41] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 60.6] [OP Surgery  (%BC): 60.6] [Observation (%BC): 60.6] [Emergency Department (%BC): 60.6] [Occupational Therapy (%BC): 60.6] [Physical Therapy (%BC): 60.6] [Respiratory Services/Therapy  (%BC): 60.6] [Speech Therapy (%BC): 60.6] [All Other OP (%BC): 60.6]","count":"1 through 10","median_amount":392.98,"10th_percentile":392.98,"90th_percentile":392.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Bluecard Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [Emergency Department ($): 40]","count":"1 through 10","median_amount":47.14,"10th_percentile":47.14,"90th_percentile":54.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":170.56,"10th_percentile":170.56,"90th_percentile":170.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 79.2] [OP Surgery  (%BC): 79.2] [Observation (%BC): 79.2] [Emergency Department (%BC): 79.2] [Occupational Therapy (%BC): 79.2] [Physical Therapy (%BC): 79.2] [Respiratory Services/Therapy  (%BC): 79.2] [Speech Therapy (%BC): 79.2] [All Other OP (%BC): 79.2]","count":"1 through 10","median_amount":503.62,"10th_percentile":503.62,"90th_percentile":821.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74] [Observation (%BC): 74] [Emergency Department (%BC): 74] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 74] [Physical Therapy (%BC): 74] [Respiratory Services/Therapy  (%BC): 74] [Speech Therapy (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 78] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 39] [OP Surgery  (%BC): 39] [Observation (%BC): 39] [Emergency Department (%BC): 39] [Occupational Therapy (%BC): 39] [Physical Therapy (%BC): 39] [Respiratory Services/Therapy  (%BC): 39] [Speech Therapy (%BC): 39] [All Other OP (%BC): 39]","count":"1 through 10","median_amount":248.0,"10th_percentile":248.0,"90th_percentile":248.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"1 through 10","median_amount":237.49,"10th_percentile":237.49,"90th_percentile":247.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Mycare Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 75] [OP Surgery  (%BC): 75] [Observation (%BC): 75] [Emergency Department (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [All Other OP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72] [OP Surgery  (%BC): 72] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 72] [Physical Therapy (%BC): 72] [Respiratory Services/Therapy  (%BC): 72] [Speech Therapy (%BC): 72] [All Other OP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [ED Level 1--99281 ($): 27.09] [ED Level 2--99282 ($): 41.69] [ED Level 3--99283 ($): 73.69] [ED Level 4--99284 ($): 123.51] [ED Level 5--99285 ($): 223.93] [Clinic Visit ($): 59.34] [OP High Cost Drugs (%BC): 40] [Other Outpatient Implant (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Musculoskeletal Procedures","code_information":[{"code":"5111","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 84] [OP Surgery  (%BC): 84] [Observation (%BC): 84] [Emergency Department (%BC): 84] [Occupational Therapy (%BC): 84] [Physical Therapy (%BC): 84] [Respiratory Services/Therapy  (%BC): 84] [Speech Therapy (%BC): 84] [All Other OP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41.82] [OP Surgery  (%BC): 41.82] [Observation (%BC): 41.82] [Emergency Department (%BC): 41.82] [Occupational Therapy (%BC): 41.82] [Physical Therapy (%BC): 41.82] [Respiratory Services/Therapy  (%BC): 41.82] [Speech Therapy (%BC): 41.82] [All Other OP (%BC): 41.82]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [All OP services (%BC): 77.4] [OP Surgery  (%BC): 77.4] [Observation (%BC): 77.4] [Emergency Department (%BC): 77.4] [Occupational Therapy (%BC): 77.4] [Physical Therapy (%BC): 77.4] [Respiratory Services/Therapy  (%BC): 77.4] [Speech Therapy (%BC): 77.4] [All Other OP (%BC): 77.4]","count":"1 through 10","median_amount":10328.67,"10th_percentile":10328.67,"90th_percentile":10328.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41] [OP Surgery  (%BC): 41] [Observation (%BC): 41] [Emergency Department (%BC): 41] [Occupational Therapy (%BC): 41] [Physical Therapy (%BC): 41] [Respiratory Services/Therapy  (%BC): 41] [Speech Therapy (%BC): 41] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 60.6] [OP Surgery  (%BC): 60.6] [Observation (%BC): 60.6] [Emergency Department (%BC): 60.6] [Occupational Therapy (%BC): 60.6] [Physical Therapy (%BC): 60.6] [Respiratory Services/Therapy  (%BC): 60.6] [Speech Therapy (%BC): 60.6] [All Other OP (%BC): 60.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Bluecard Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [Emergency Department ($): 40]","count":"1 through 10","median_amount":727.34,"10th_percentile":727.34,"90th_percentile":727.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 79.2] [OP Surgery  (%BC): 79.2] [Observation (%BC): 79.2] [Emergency Department (%BC): 79.2] [Occupational Therapy (%BC): 79.2] [Physical Therapy (%BC): 79.2] [Respiratory Services/Therapy  (%BC): 79.2] [Speech Therapy (%BC): 79.2] [All Other OP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74] [Observation (%BC): 74] [Emergency Department (%BC): 74] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 74] [Physical Therapy (%BC): 74] [Respiratory Services/Therapy  (%BC): 74] [Speech Therapy (%BC): 74] [All Other OP (%BC): 74]","count":"1 through 10","median_amount":9987.93,"10th_percentile":9987.93,"90th_percentile":9987.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 78] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"1 through 10","median_amount":373.85,"10th_percentile":373.85,"90th_percentile":373.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 39] [OP Surgery  (%BC): 39] [Observation (%BC): 39] [Emergency Department (%BC): 39] [Occupational Therapy (%BC): 39] [Physical Therapy (%BC): 39] [Respiratory Services/Therapy  (%BC): 39] [Speech Therapy (%BC): 39] [All Other OP (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"1 through 10","median_amount":11235.91,"10th_percentile":11235.91,"90th_percentile":11235.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Mycare Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 75] [OP Surgery  (%BC): 75] [Observation (%BC): 75] [Emergency Department (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [All Other OP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72] [OP Surgery  (%BC): 72] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 72] [Physical Therapy (%BC): 72] [Respiratory Services/Therapy  (%BC): 72] [Speech Therapy (%BC): 72] [All Other OP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"1 through 10","median_amount":886.61,"10th_percentile":886.61,"90th_percentile":886.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [ED Level 1--99281 ($): 27.09] [ED Level 2--99282 ($): 41.69] [ED Level 3--99283 ($): 73.69] [ED Level 4--99284 ($): 123.51] [ED Level 5--99285 ($): 223.93] [Clinic Visit ($): 59.34] [OP High Cost Drugs (%BC): 40] [Other Outpatient Implant (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Musculoskeletal Procedures","code_information":[{"code":"5112","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 84] [OP Surgery  (%BC): 84] [Observation (%BC): 84] [Emergency Department (%BC): 84] [Occupational Therapy (%BC): 84] [Physical Therapy (%BC): 84] [Respiratory Services/Therapy  (%BC): 84] [Speech Therapy (%BC): 84] [All Other OP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":1535.83,"10th_percentile":1535.83,"90th_percentile":1535.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41.82] [OP Surgery  (%BC): 41.82] [Observation (%BC): 41.82] [Emergency Department (%BC): 41.82] [Occupational Therapy (%BC): 41.82] [Physical Therapy (%BC): 41.82] [Respiratory Services/Therapy  (%BC): 41.82] [Speech Therapy (%BC): 41.82] [All Other OP (%BC): 41.82]","count":"1 through 10","median_amount":2407.88,"10th_percentile":2407.88,"90th_percentile":2407.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [All OP services (%BC): 77.4] [OP Surgery  (%BC): 77.4] [Observation (%BC): 77.4] [Emergency Department (%BC): 77.4] [Occupational Therapy (%BC): 77.4] [Physical Therapy (%BC): 77.4] [Respiratory Services/Therapy  (%BC): 77.4] [Speech Therapy (%BC): 77.4] [All Other OP (%BC): 77.4]","count":"12","median_amount":4351.95,"10th_percentile":4288.04,"90th_percentile":6469.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41] [OP Surgery  (%BC): 41] [Observation (%BC): 41] [Emergency Department (%BC): 41] [Occupational Therapy (%BC): 41] [Physical Therapy (%BC): 41] [Respiratory Services/Therapy  (%BC): 41] [Speech Therapy (%BC): 41] [All Other OP (%BC): 41]","count":"1 through 10","median_amount":2410.1,"10th_percentile":2410.1,"90th_percentile":2410.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 60.6] [OP Surgery  (%BC): 60.6] [Observation (%BC): 60.6] [Emergency Department (%BC): 60.6] [Occupational Therapy (%BC): 60.6] [Physical Therapy (%BC): 60.6] [Respiratory Services/Therapy  (%BC): 60.6] [Speech Therapy (%BC): 60.6] [All Other OP (%BC): 60.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Bluecard Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [Emergency Department ($): 40]","count":"1 through 10","median_amount":1757.55,"10th_percentile":703.0,"90th_percentile":1818.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 79.2] [OP Surgery  (%BC): 79.2] [Observation (%BC): 79.2] [Emergency Department (%BC): 79.2] [Occupational Therapy (%BC): 79.2] [Physical Therapy (%BC): 79.2] [Respiratory Services/Therapy  (%BC): 79.2] [Speech Therapy (%BC): 79.2] [All Other OP (%BC): 79.2]","count":"1 through 10","median_amount":3169.51,"10th_percentile":3169.51,"90th_percentile":3169.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74] [Observation (%BC): 74] [Emergency Department (%BC): 74] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 74] [Physical Therapy (%BC): 74] [Respiratory Services/Therapy  (%BC): 74] [Speech Therapy (%BC): 74] [All Other OP (%BC): 74]","count":"1 through 10","median_amount":4474.26,"10th_percentile":4474.26,"90th_percentile":4474.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 78] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 39] [OP Surgery  (%BC): 39] [Observation (%BC): 39] [Emergency Department (%BC): 39] [Occupational Therapy (%BC): 39] [Physical Therapy (%BC): 39] [Respiratory Services/Therapy  (%BC): 39] [Speech Therapy (%BC): 39] [All Other OP (%BC): 39]","count":"1 through 10","median_amount":1869.95,"10th_percentile":1712.83,"90th_percentile":2835.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"1 through 10","median_amount":4448.94,"10th_percentile":3117.73,"90th_percentile":6488.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Mycare Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 75] [OP Surgery  (%BC): 75] [Observation (%BC): 75] [Emergency Department (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [All Other OP (%BC): 75]","count":"1 through 10","median_amount":2353.3,"10th_percentile":2000.61,"90th_percentile":6677.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72] [OP Surgery  (%BC): 72] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 72] [Physical Therapy (%BC): 72] [Respiratory Services/Therapy  (%BC): 72] [Speech Therapy (%BC): 72] [All Other OP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [ED Level 1--99281 ($): 27.09] [ED Level 2--99282 ($): 41.69] [ED Level 3--99283 ($): 73.69] [ED Level 4--99284 ($): 123.51] [ED Level 5--99285 ($): 223.93] [Clinic Visit ($): 59.34] [OP High Cost Drugs (%BC): 40] [Other Outpatient Implant (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"1 through 10","median_amount":2367.44,"10th_percentile":2358.06,"90th_percentile":16797.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Musculoskeletal Procedures","code_information":[{"code":"5113","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 84] [OP Surgery  (%BC): 84] [Observation (%BC): 84] [Emergency Department (%BC): 84] [Occupational Therapy (%BC): 84] [Physical Therapy (%BC): 84] [Respiratory Services/Therapy  (%BC): 84] [Speech Therapy (%BC): 84] [All Other OP (%BC): 84]","count":"1 through 10","median_amount":1831.84,"10th_percentile":1831.84,"90th_percentile":1831.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41.82] [OP Surgery  (%BC): 41.82] [Observation (%BC): 41.82] [Emergency Department (%BC): 41.82] [Occupational Therapy (%BC): 41.82] [Physical Therapy (%BC): 41.82] [Respiratory Services/Therapy  (%BC): 41.82] [Speech Therapy (%BC): 41.82] [All Other OP (%BC): 41.82]","count":"1 through 10","median_amount":3326.15,"10th_percentile":2585.66,"90th_percentile":8457.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [All OP services (%BC): 77.4] [OP Surgery  (%BC): 77.4] [Observation (%BC): 77.4] [Emergency Department (%BC): 77.4] [Occupational Therapy (%BC): 77.4] [Physical Therapy (%BC): 77.4] [Respiratory Services/Therapy  (%BC): 77.4] [Speech Therapy (%BC): 77.4] [All Other OP (%BC): 77.4]","count":"18","median_amount":8389.87,"10th_percentile":6427.68,"90th_percentile":12512.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"1 through 10","median_amount":3996.69,"10th_percentile":3996.69,"90th_percentile":3996.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41] [OP Surgery  (%BC): 41] [Observation (%BC): 41] [Emergency Department (%BC): 41] [Occupational Therapy (%BC): 41] [Physical Therapy (%BC): 41] [Respiratory Services/Therapy  (%BC): 41] [Speech Therapy (%BC): 41] [All Other OP (%BC): 41]","count":"1 through 10","median_amount":8295.05,"10th_percentile":4649.61,"90th_percentile":8768.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 60.6] [OP Surgery  (%BC): 60.6] [Observation (%BC): 60.6] [Emergency Department (%BC): 60.6] [Occupational Therapy (%BC): 60.6] [Physical Therapy (%BC): 60.6] [Respiratory Services/Therapy  (%BC): 60.6] [Speech Therapy (%BC): 60.6] [All Other OP (%BC): 60.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Bluecard Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [Emergency Department ($): 40]","count":"1 through 10","median_amount":2850.62,"10th_percentile":2731.43,"90th_percentile":5608.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":3707.8,"10th_percentile":3707.8,"90th_percentile":3707.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 79.2] [OP Surgery  (%BC): 79.2] [Observation (%BC): 79.2] [Emergency Department (%BC): 79.2] [Occupational Therapy (%BC): 79.2] [Physical Therapy (%BC): 79.2] [Respiratory Services/Therapy  (%BC): 79.2] [Speech Therapy (%BC): 79.2] [All Other OP (%BC): 79.2]","count":"1 through 10","median_amount":9131.29,"10th_percentile":9131.29,"90th_percentile":9131.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74] [Observation (%BC): 74] [Emergency Department (%BC): 74] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 74] [Physical Therapy (%BC): 74] [Respiratory Services/Therapy  (%BC): 74] [Speech Therapy (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 78] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"1 through 10","median_amount":2893.01,"10th_percentile":2893.01,"90th_percentile":2893.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 39] [OP Surgery  (%BC): 39] [Observation (%BC): 39] [Emergency Department (%BC): 39] [Occupational Therapy (%BC): 39] [Physical Therapy (%BC): 39] [Respiratory Services/Therapy  (%BC): 39] [Speech Therapy (%BC): 39] [All Other OP (%BC): 39]","count":"1 through 10","median_amount":3810.23,"10th_percentile":3810.23,"90th_percentile":10705.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"16","median_amount":8154.19,"10th_percentile":6599.83,"90th_percentile":10649.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Mycare Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 75] [OP Surgery  (%BC): 75] [Observation (%BC): 75] [Emergency Department (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [All Other OP (%BC): 75]","count":"1 through 10","median_amount":4838.13,"10th_percentile":3430.69,"90th_percentile":8645.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72] [OP Surgery  (%BC): 72] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 72] [Physical Therapy (%BC): 72] [Respiratory Services/Therapy  (%BC): 72] [Speech Therapy (%BC): 72] [All Other OP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"1 through 10","median_amount":10560.93,"10th_percentile":10560.93,"90th_percentile":10560.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"1 through 10","median_amount":4180.33,"10th_percentile":4180.33,"90th_percentile":20168.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [ED Level 1--99281 ($): 27.09] [ED Level 2--99282 ($): 41.69] [ED Level 3--99283 ($): 73.69] [ED Level 4--99284 ($): 123.51] [ED Level 5--99285 ($): 223.93] [Clinic Visit ($): 59.34] [OP High Cost Drugs (%BC): 40] [Other Outpatient Implant (%BC): 40]","count":"1 through 10","median_amount":2755.25,"10th_percentile":2755.25,"90th_percentile":2755.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"1 through 10","median_amount":4485.51,"10th_percentile":3650.58,"90th_percentile":6124.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Musculoskeletal Procedures","code_information":[{"code":"5114","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 84] [OP Surgery  (%BC): 84] [Observation (%BC): 84] [Emergency Department (%BC): 84] [Occupational Therapy (%BC): 84] [Physical Therapy (%BC): 84] [Respiratory Services/Therapy  (%BC): 84] [Speech Therapy (%BC): 84] [All Other OP (%BC): 84]","count":"1 through 10","median_amount":1506.32,"10th_percentile":1506.32,"90th_percentile":4439.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41.82] [OP Surgery  (%BC): 41.82] [Observation (%BC): 41.82] [Emergency Department (%BC): 41.82] [Occupational Therapy (%BC): 41.82] [Physical Therapy (%BC): 41.82] [Respiratory Services/Therapy  (%BC): 41.82] [Speech Therapy (%BC): 41.82] [All Other OP (%BC): 41.82]","count":"1 through 10","median_amount":9716.5,"10th_percentile":3722.19,"90th_percentile":12589.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [All OP services (%BC): 77.4] [OP Surgery  (%BC): 77.4] [Observation (%BC): 77.4] [Emergency Department (%BC): 77.4] [Occupational Therapy (%BC): 77.4] [Physical Therapy (%BC): 77.4] [Respiratory Services/Therapy  (%BC): 77.4] [Speech Therapy (%BC): 77.4] [All Other OP (%BC): 77.4]","count":"25","median_amount":8304.08,"10th_percentile":3937.21,"90th_percentile":19501.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"1 through 10","median_amount":12052.67,"10th_percentile":12052.67,"90th_percentile":12052.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41] [OP Surgery  (%BC): 41] [Observation (%BC): 41] [Emergency Department (%BC): 41] [Occupational Therapy (%BC): 41] [Physical Therapy (%BC): 41] [Respiratory Services/Therapy  (%BC): 41] [Speech Therapy (%BC): 41] [All Other OP (%BC): 41]","count":"1 through 10","median_amount":5796.88,"10th_percentile":4812.08,"90th_percentile":8394.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 60.6] [OP Surgery  (%BC): 60.6] [Observation (%BC): 60.6] [Emergency Department (%BC): 60.6] [Occupational Therapy (%BC): 60.6] [Physical Therapy (%BC): 60.6] [Respiratory Services/Therapy  (%BC): 60.6] [Speech Therapy (%BC): 60.6] [All Other OP (%BC): 60.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Bluecard Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":4248.6,"10th_percentile":4248.6,"90th_percentile":4248.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [Emergency Department ($): 40]","count":"1 through 10","median_amount":5876.29,"10th_percentile":5420.66,"90th_percentile":8754.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":5608.28,"10th_percentile":5608.28,"90th_percentile":5608.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 79.2] [OP Surgery  (%BC): 79.2] [Observation (%BC): 79.2] [Emergency Department (%BC): 79.2] [Occupational Therapy (%BC): 79.2] [Physical Therapy (%BC): 79.2] [Respiratory Services/Therapy  (%BC): 79.2] [Speech Therapy (%BC): 79.2] [All Other OP (%BC): 79.2]","count":"1 through 10","median_amount":14280.34,"10th_percentile":14280.34,"90th_percentile":27742.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74] [Observation (%BC): 74] [Emergency Department (%BC): 74] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 74] [Physical Therapy (%BC): 74] [Respiratory Services/Therapy  (%BC): 74] [Speech Therapy (%BC): 74] [All Other OP (%BC): 74]","count":"1 through 10","median_amount":11546.05,"10th_percentile":11546.05,"90th_percentile":11546.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 78] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"1 through 10","median_amount":5888.69,"10th_percentile":5888.69,"90th_percentile":6918.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 39] [OP Surgery  (%BC): 39] [Observation (%BC): 39] [Emergency Department (%BC): 39] [Occupational Therapy (%BC): 39] [Physical Therapy (%BC): 39] [Respiratory Services/Therapy  (%BC): 39] [Speech Therapy (%BC): 39] [All Other OP (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"1 through 10","median_amount":13662.67,"10th_percentile":7328.54,"90th_percentile":25331.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Mycare Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 75] [OP Surgery  (%BC): 75] [Observation (%BC): 75] [Emergency Department (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [All Other OP (%BC): 75]","count":"1 through 10","median_amount":11978.72,"10th_percentile":5761.05,"90th_percentile":23820.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72] [OP Surgery  (%BC): 72] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 72] [Physical Therapy (%BC): 72] [Respiratory Services/Therapy  (%BC): 72] [Speech Therapy (%BC): 72] [All Other OP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"1 through 10","median_amount":13024.32,"10th_percentile":13024.32,"90th_percentile":16428.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"1 through 10","median_amount":8706.51,"10th_percentile":8706.51,"90th_percentile":8706.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [ED Level 1--99281 ($): 27.09] [ED Level 2--99282 ($): 41.69] [ED Level 3--99283 ($): 73.69] [ED Level 4--99284 ($): 123.51] [ED Level 5--99285 ($): 223.93] [Clinic Visit ($): 59.34] [OP High Cost Drugs (%BC): 40] [Other Outpatient Implant (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"1 through 10","median_amount":9555.09,"10th_percentile":8276.35,"90th_percentile":32340.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":14383.01,"10th_percentile":14383.01,"90th_percentile":14383.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 5 Musculoskeletal Procedures","code_information":[{"code":"5115","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 84] [OP Surgery  (%BC): 84] [Observation (%BC): 84] [Emergency Department (%BC): 84] [Occupational Therapy (%BC): 84] [Physical Therapy (%BC): 84] [Respiratory Services/Therapy  (%BC): 84] [Speech Therapy (%BC): 84] [All Other OP (%BC): 84]","count":"1 through 10","median_amount":4939.68,"10th_percentile":4939.68,"90th_percentile":4939.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41.82] [OP Surgery  (%BC): 41.82] [Observation (%BC): 41.82] [Emergency Department (%BC): 41.82] [Occupational Therapy (%BC): 41.82] [Physical Therapy (%BC): 41.82] [Respiratory Services/Therapy  (%BC): 41.82] [Speech Therapy (%BC): 41.82] [All Other OP (%BC): 41.82]","count":"20","median_amount":14318.39,"10th_percentile":11455.65,"90th_percentile":16950.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [All OP services (%BC): 77.4] [OP Surgery  (%BC): 77.4] [Observation (%BC): 77.4] [Emergency Department (%BC): 77.4] [Occupational Therapy (%BC): 77.4] [Physical Therapy (%BC): 77.4] [Respiratory Services/Therapy  (%BC): 77.4] [Speech Therapy (%BC): 77.4] [All Other OP (%BC): 77.4]","count":"35","median_amount":29703.27,"10th_percentile":8976.77,"90th_percentile":37255.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41] [OP Surgery  (%BC): 41] [Observation (%BC): 41] [Emergency Department (%BC): 41] [Occupational Therapy (%BC): 41] [Physical Therapy (%BC): 41] [Respiratory Services/Therapy  (%BC): 41] [Speech Therapy (%BC): 41] [All Other OP (%BC): 41]","count":"1 through 10","median_amount":13076.39,"10th_percentile":12483.96,"90th_percentile":21217.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 60.6] [OP Surgery  (%BC): 60.6] [Observation (%BC): 60.6] [Emergency Department (%BC): 60.6] [Occupational Therapy (%BC): 60.6] [Physical Therapy (%BC): 60.6] [Respiratory Services/Therapy  (%BC): 60.6] [Speech Therapy (%BC): 60.6] [All Other OP (%BC): 60.6]","count":"1 through 10","median_amount":18916.58,"10th_percentile":18916.58,"90th_percentile":18916.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Bluecard Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [Emergency Department ($): 40]","count":"1 through 10","median_amount":12747.3,"10th_percentile":12320.87,"90th_percentile":12747.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 79.2] [OP Surgery  (%BC): 79.2] [Observation (%BC): 79.2] [Emergency Department (%BC): 79.2] [Occupational Therapy (%BC): 79.2] [Physical Therapy (%BC): 79.2] [Respiratory Services/Therapy  (%BC): 79.2] [Speech Therapy (%BC): 79.2] [All Other OP (%BC): 79.2]","count":"1 through 10","median_amount":31448.78,"10th_percentile":31448.78,"90th_percentile":31448.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":31168.55,"10th_percentile":31168.55,"90th_percentile":31168.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74] [Observation (%BC): 74] [Emergency Department (%BC): 74] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 74] [Physical Therapy (%BC): 74] [Respiratory Services/Therapy  (%BC): 74] [Speech Therapy (%BC): 74] [All Other OP (%BC): 74]","count":"1 through 10","median_amount":34507.41,"10th_percentile":34507.41,"90th_percentile":34507.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 78] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"1 through 10","median_amount":13384.67,"10th_percentile":13384.67,"90th_percentile":13384.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 39] [OP Surgery  (%BC): 39] [Observation (%BC): 39] [Emergency Department (%BC): 39] [Occupational Therapy (%BC): 39] [Physical Therapy (%BC): 39] [Respiratory Services/Therapy  (%BC): 39] [Speech Therapy (%BC): 39] [All Other OP (%BC): 39]","count":"17","median_amount":8974.3,"10th_percentile":590.0,"90th_percentile":14148.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"20","median_amount":26020.1,"10th_percentile":2464.56,"90th_percentile":37839.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":1620.94,"10th_percentile":1620.94,"90th_percentile":1620.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Mycare Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 75] [OP Surgery  (%BC): 75] [Observation (%BC): 75] [Emergency Department (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [All Other OP (%BC): 75]","count":"13","median_amount":25331.07,"10th_percentile":12979.4,"90th_percentile":30197.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72] [OP Surgery  (%BC): 72] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 72] [Physical Therapy (%BC): 72] [Respiratory Services/Therapy  (%BC): 72] [Speech Therapy (%BC): 72] [All Other OP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"1 through 10","median_amount":28778.37,"10th_percentile":28778.37,"90th_percentile":33035.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"1 through 10","median_amount":32407.01,"10th_percentile":32407.01,"90th_percentile":54347.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [ED Level 1--99281 ($): 27.09] [ED Level 2--99282 ($): 41.69] [ED Level 3--99283 ($): 73.69] [ED Level 4--99284 ($): 123.51] [ED Level 5--99285 ($): 223.93] [Clinic Visit ($): 59.34] [OP High Cost Drugs (%BC): 40] [Other Outpatient Implant (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"16","median_amount":19277.19,"10th_percentile":13859.04,"90th_percentile":34596.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 6 Musculoskeletal Procedures","code_information":[{"code":"5116","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 84] [OP Surgery  (%BC): 84] [Observation (%BC): 84] [Emergency Department (%BC): 84] [Occupational Therapy (%BC): 84] [Physical Therapy (%BC): 84] [Respiratory Services/Therapy  (%BC): 84] [Speech Therapy (%BC): 84] [All Other OP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41.82] [OP Surgery  (%BC): 41.82] [Observation (%BC): 41.82] [Emergency Department (%BC): 41.82] [Occupational Therapy (%BC): 41.82] [Physical Therapy (%BC): 41.82] [Respiratory Services/Therapy  (%BC): 41.82] [Speech Therapy (%BC): 41.82] [All Other OP (%BC): 41.82]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [All OP services (%BC): 77.4] [OP Surgery  (%BC): 77.4] [Observation (%BC): 77.4] [Emergency Department (%BC): 77.4] [Occupational Therapy (%BC): 77.4] [Physical Therapy (%BC): 77.4] [Respiratory Services/Therapy  (%BC): 77.4] [Speech Therapy (%BC): 77.4] [All Other OP (%BC): 77.4]","count":"1 through 10","median_amount":37198.62,"10th_percentile":36974.12,"90th_percentile":48099.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41] [OP Surgery  (%BC): 41] [Observation (%BC): 41] [Emergency Department (%BC): 41] [Occupational Therapy (%BC): 41] [Physical Therapy (%BC): 41] [Respiratory Services/Therapy  (%BC): 41] [Speech Therapy (%BC): 41] [All Other OP (%BC): 41]","count":"1 through 10","median_amount":18238.41,"10th_percentile":18238.41,"90th_percentile":18238.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 60.6] [OP Surgery  (%BC): 60.6] [Observation (%BC): 60.6] [Emergency Department (%BC): 60.6] [Occupational Therapy (%BC): 60.6] [Physical Therapy (%BC): 60.6] [Respiratory Services/Therapy  (%BC): 60.6] [Speech Therapy (%BC): 60.6] [All Other OP (%BC): 60.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Bluecard Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [Emergency Department ($): 40]","count":"1 through 10","median_amount":12169.47,"10th_percentile":12169.47,"90th_percentile":12169.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 79.2] [OP Surgery  (%BC): 79.2] [Observation (%BC): 79.2] [Emergency Department (%BC): 79.2] [Occupational Therapy (%BC): 79.2] [Physical Therapy (%BC): 79.2] [Respiratory Services/Therapy  (%BC): 79.2] [Speech Therapy (%BC): 79.2] [All Other OP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74] [Observation (%BC): 74] [Emergency Department (%BC): 74] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 74] [Physical Therapy (%BC): 74] [Respiratory Services/Therapy  (%BC): 74] [Speech Therapy (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 78] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 39] [OP Surgery  (%BC): 39] [Observation (%BC): 39] [Emergency Department (%BC): 39] [Occupational Therapy (%BC): 39] [Physical Therapy (%BC): 39] [Respiratory Services/Therapy  (%BC): 39] [Speech Therapy (%BC): 39] [All Other OP (%BC): 39]","count":"1 through 10","median_amount":17671.17,"10th_percentile":17671.17,"90th_percentile":17671.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Mycare Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 75] [OP Surgery  (%BC): 75] [Observation (%BC): 75] [Emergency Department (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [All Other OP (%BC): 75]","count":"1 through 10","median_amount":20106.31,"10th_percentile":20106.31,"90th_percentile":20106.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72] [OP Surgery  (%BC): 72] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 72] [Physical Therapy (%BC): 72] [Respiratory Services/Therapy  (%BC): 72] [Speech Therapy (%BC): 72] [All Other OP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [ED Level 1--99281 ($): 27.09] [ED Level 2--99282 ($): 41.69] [ED Level 3--99283 ($): 73.69] [ED Level 4--99284 ($): 123.51] [ED Level 5--99285 ($): 223.93] [Clinic Visit ($): 59.34] [OP High Cost Drugs (%BC): 40] [Other Outpatient Implant (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"1 through 10","median_amount":25026.8,"10th_percentile":25026.8,"90th_percentile":25026.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Vascular Procedures","code_information":[{"code":"5181","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 84] [OP Surgery  (%BC): 84] [Observation (%BC): 84] [Emergency Department (%BC): 84] [Occupational Therapy (%BC): 84] [Physical Therapy (%BC): 84] [Respiratory Services/Therapy  (%BC): 84] [Speech Therapy (%BC): 84] [All Other OP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41.82] [OP Surgery  (%BC): 41.82] [Observation (%BC): 41.82] [Emergency Department (%BC): 41.82] [Occupational Therapy (%BC): 41.82] [Physical Therapy (%BC): 41.82] [Respiratory Services/Therapy  (%BC): 41.82] [Speech Therapy (%BC): 41.82] [All Other OP (%BC): 41.82]","count":"1 through 10","median_amount":1045.81,"10th_percentile":1045.81,"90th_percentile":1045.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [All OP services (%BC): 77.4] [OP Surgery  (%BC): 77.4] [Observation (%BC): 77.4] [Emergency Department (%BC): 77.4] [Occupational Therapy (%BC): 77.4] [Physical Therapy (%BC): 77.4] [Respiratory Services/Therapy  (%BC): 77.4] [Speech Therapy (%BC): 77.4] [All Other OP (%BC): 77.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"1 through 10","median_amount":4788.05,"10th_percentile":4788.05,"90th_percentile":4788.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41] [OP Surgery  (%BC): 41] [Observation (%BC): 41] [Emergency Department (%BC): 41] [Occupational Therapy (%BC): 41] [Physical Therapy (%BC): 41] [Respiratory Services/Therapy  (%BC): 41] [Speech Therapy (%BC): 41] [All Other OP (%BC): 41]","count":"1 through 10","median_amount":799.73,"10th_percentile":524.66,"90th_percentile":1958.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 60.6] [OP Surgery  (%BC): 60.6] [Observation (%BC): 60.6] [Emergency Department (%BC): 60.6] [Occupational Therapy (%BC): 60.6] [Physical Therapy (%BC): 60.6] [Respiratory Services/Therapy  (%BC): 60.6] [Speech Therapy (%BC): 60.6] [All Other OP (%BC): 60.6]","count":"1 through 10","median_amount":1636.32,"10th_percentile":985.49,"90th_percentile":2514.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Bluecard Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [Emergency Department ($): 40]","count":"1 through 10","median_amount":2793.82,"10th_percentile":2793.82,"90th_percentile":2793.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 79.2] [OP Surgery  (%BC): 79.2] [Observation (%BC): 79.2] [Emergency Department (%BC): 79.2] [Occupational Therapy (%BC): 79.2] [Physical Therapy (%BC): 79.2] [Respiratory Services/Therapy  (%BC): 79.2] [Speech Therapy (%BC): 79.2] [All Other OP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74] [Observation (%BC): 74] [Emergency Department (%BC): 74] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 74] [Physical Therapy (%BC): 74] [Respiratory Services/Therapy  (%BC): 74] [Speech Therapy (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 78] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 39] [OP Surgery  (%BC): 39] [Observation (%BC): 39] [Emergency Department (%BC): 39] [Occupational Therapy (%BC): 39] [Physical Therapy (%BC): 39] [Respiratory Services/Therapy  (%BC): 39] [Speech Therapy (%BC): 39] [All Other OP (%BC): 39]","count":"1 through 10","median_amount":124.84,"10th_percentile":124.84,"90th_percentile":124.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Mycare Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 75] [OP Surgery  (%BC): 75] [Observation (%BC): 75] [Emergency Department (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [All Other OP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72] [OP Surgery  (%BC): 72] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 72] [Physical Therapy (%BC): 72] [Respiratory Services/Therapy  (%BC): 72] [Speech Therapy (%BC): 72] [All Other OP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [ED Level 1--99281 ($): 27.09] [ED Level 2--99282 ($): 41.69] [ED Level 3--99283 ($): 73.69] [ED Level 4--99284 ($): 123.51] [ED Level 5--99285 ($): 223.93] [Clinic Visit ($): 59.34] [OP High Cost Drugs (%BC): 40] [Other Outpatient Implant (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"1 through 10","median_amount":3706.89,"10th_percentile":3706.89,"90th_percentile":3706.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"1 through 10","median_amount":484.2,"10th_percentile":484.2,"90th_percentile":484.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Vascular Procedures","code_information":[{"code":"5182","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 84] [OP Surgery  (%BC): 84] [Observation (%BC): 84] [Emergency Department (%BC): 84] [Occupational Therapy (%BC): 84] [Physical Therapy (%BC): 84] [Respiratory Services/Therapy  (%BC): 84] [Speech Therapy (%BC): 84] [All Other OP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41.82] [OP Surgery  (%BC): 41.82] [Observation (%BC): 41.82] [Emergency Department (%BC): 41.82] [Occupational Therapy (%BC): 41.82] [Physical Therapy (%BC): 41.82] [Respiratory Services/Therapy  (%BC): 41.82] [Speech Therapy (%BC): 41.82] [All Other OP (%BC): 41.82]","count":"1 through 10","median_amount":865.69,"10th_percentile":865.69,"90th_percentile":865.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [All OP services (%BC): 77.4] [OP Surgery  (%BC): 77.4] [Observation (%BC): 77.4] [Emergency Department (%BC): 77.4] [Occupational Therapy (%BC): 77.4] [Physical Therapy (%BC): 77.4] [Respiratory Services/Therapy  (%BC): 77.4] [Speech Therapy (%BC): 77.4] [All Other OP (%BC): 77.4]","count":"1 through 10","median_amount":2785.23,"10th_percentile":2785.23,"90th_percentile":2785.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41] [OP Surgery  (%BC): 41] [Observation (%BC): 41] [Emergency Department (%BC): 41] [Occupational Therapy (%BC): 41] [Physical Therapy (%BC): 41] [Respiratory Services/Therapy  (%BC): 41] [Speech Therapy (%BC): 41] [All Other OP (%BC): 41]","count":"1 through 10","median_amount":1160.23,"10th_percentile":922.56,"90th_percentile":9493.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 60.6] [OP Surgery  (%BC): 60.6] [Observation (%BC): 60.6] [Emergency Department (%BC): 60.6] [Occupational Therapy (%BC): 60.6] [Physical Therapy (%BC): 60.6] [Respiratory Services/Therapy  (%BC): 60.6] [Speech Therapy (%BC): 60.6] [All Other OP (%BC): 60.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Bluecard Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [Emergency Department ($): 40]","count":"1 through 10","median_amount":1551.66,"10th_percentile":1551.66,"90th_percentile":1551.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 79.2] [OP Surgery  (%BC): 79.2] [Observation (%BC): 79.2] [Emergency Department (%BC): 79.2] [Occupational Therapy (%BC): 79.2] [Physical Therapy (%BC): 79.2] [Respiratory Services/Therapy  (%BC): 79.2] [Speech Therapy (%BC): 79.2] [All Other OP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74] [Observation (%BC): 74] [Emergency Department (%BC): 74] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 74] [Physical Therapy (%BC): 74] [Respiratory Services/Therapy  (%BC): 74] [Speech Therapy (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 78] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 39] [OP Surgery  (%BC): 39] [Observation (%BC): 39] [Emergency Department (%BC): 39] [Occupational Therapy (%BC): 39] [Physical Therapy (%BC): 39] [Respiratory Services/Therapy  (%BC): 39] [Speech Therapy (%BC): 39] [All Other OP (%BC): 39]","count":"1 through 10","median_amount":2153.79,"10th_percentile":2153.79,"90th_percentile":2153.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":2604.43,"10th_percentile":2604.43,"90th_percentile":2604.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Mycare Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 75] [OP Surgery  (%BC): 75] [Observation (%BC): 75] [Emergency Department (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [All Other OP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72] [OP Surgery  (%BC): 72] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 72] [Physical Therapy (%BC): 72] [Respiratory Services/Therapy  (%BC): 72] [Speech Therapy (%BC): 72] [All Other OP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [ED Level 1--99281 ($): 27.09] [ED Level 2--99282 ($): 41.69] [ED Level 3--99283 ($): 73.69] [ED Level 4--99284 ($): 123.51] [ED Level 5--99285 ($): 223.93] [Clinic Visit ($): 59.34] [OP High Cost Drugs (%BC): 40] [Other Outpatient Implant (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"1 through 10","median_amount":13245.82,"10th_percentile":13245.82,"90th_percentile":13245.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"1 through 10","median_amount":2920.52,"10th_percentile":2920.52,"90th_percentile":2920.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":8430.48,"10th_percentile":8430.48,"90th_percentile":8430.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Vascular Procedures","code_information":[{"code":"5183","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 84] [OP Surgery  (%BC): 84] [Observation (%BC): 84] [Emergency Department (%BC): 84] [Occupational Therapy (%BC): 84] [Physical Therapy (%BC): 84] [Respiratory Services/Therapy  (%BC): 84] [Speech Therapy (%BC): 84] [All Other OP (%BC): 84]","count":"1 through 10","median_amount":6767.59,"10th_percentile":6767.59,"90th_percentile":6767.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":3835.45,"10th_percentile":3835.45,"90th_percentile":3835.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41.82] [OP Surgery  (%BC): 41.82] [Observation (%BC): 41.82] [Emergency Department (%BC): 41.82] [Occupational Therapy (%BC): 41.82] [Physical Therapy (%BC): 41.82] [Respiratory Services/Therapy  (%BC): 41.82] [Speech Therapy (%BC): 41.82] [All Other OP (%BC): 41.82]","count":"1 through 10","median_amount":4550.44,"10th_percentile":4187.61,"90th_percentile":5420.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [All OP services (%BC): 77.4] [OP Surgery  (%BC): 77.4] [Observation (%BC): 77.4] [Emergency Department (%BC): 77.4] [Occupational Therapy (%BC): 77.4] [Physical Therapy (%BC): 77.4] [Respiratory Services/Therapy  (%BC): 77.4] [Speech Therapy (%BC): 77.4] [All Other OP (%BC): 77.4]","count":"1 through 10","median_amount":9256.46,"10th_percentile":8687.51,"90th_percentile":14189.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41] [OP Surgery  (%BC): 41] [Observation (%BC): 41] [Emergency Department (%BC): 41] [Occupational Therapy (%BC): 41] [Physical Therapy (%BC): 41] [Respiratory Services/Therapy  (%BC): 41] [Speech Therapy (%BC): 41] [All Other OP (%BC): 41]","count":"1 through 10","median_amount":5802.21,"10th_percentile":5802.21,"90th_percentile":5802.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 60.6] [OP Surgery  (%BC): 60.6] [Observation (%BC): 60.6] [Emergency Department (%BC): 60.6] [Occupational Therapy (%BC): 60.6] [Physical Therapy (%BC): 60.6] [Respiratory Services/Therapy  (%BC): 60.6] [Speech Therapy (%BC): 60.6] [All Other OP (%BC): 60.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Bluecard Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [Emergency Department ($): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 79.2] [OP Surgery  (%BC): 79.2] [Observation (%BC): 79.2] [Emergency Department (%BC): 79.2] [Occupational Therapy (%BC): 79.2] [Physical Therapy (%BC): 79.2] [Respiratory Services/Therapy  (%BC): 79.2] [Speech Therapy (%BC): 79.2] [All Other OP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74] [Observation (%BC): 74] [Emergency Department (%BC): 74] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 74] [Physical Therapy (%BC): 74] [Respiratory Services/Therapy  (%BC): 74] [Speech Therapy (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 78] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 39] [OP Surgery  (%BC): 39] [Observation (%BC): 39] [Emergency Department (%BC): 39] [Occupational Therapy (%BC): 39] [Physical Therapy (%BC): 39] [Respiratory Services/Therapy  (%BC): 39] [Speech Therapy (%BC): 39] [All Other OP (%BC): 39]","count":"1 through 10","median_amount":4692.74,"10th_percentile":4009.84,"90th_percentile":4777.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Mycare Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 75] [OP Surgery  (%BC): 75] [Observation (%BC): 75] [Emergency Department (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [All Other OP (%BC): 75]","count":"1 through 10","median_amount":12229.96,"10th_percentile":12229.96,"90th_percentile":12229.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72] [OP Surgery  (%BC): 72] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 72] [Physical Therapy (%BC): 72] [Respiratory Services/Therapy  (%BC): 72] [Speech Therapy (%BC): 72] [All Other OP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [ED Level 1--99281 ($): 27.09] [ED Level 2--99282 ($): 41.69] [ED Level 3--99283 ($): 73.69] [ED Level 4--99284 ($): 123.51] [ED Level 5--99285 ($): 223.93] [Clinic Visit ($): 59.34] [OP High Cost Drugs (%BC): 40] [Other Outpatient Implant (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"1 through 10","median_amount":3649.09,"10th_percentile":3649.09,"90th_percentile":3649.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Vascular Procedures","code_information":[{"code":"5184","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 84] [OP Surgery  (%BC): 84] [Observation (%BC): 84] [Emergency Department (%BC): 84] [Occupational Therapy (%BC): 84] [Physical Therapy (%BC): 84] [Respiratory Services/Therapy  (%BC): 84] [Speech Therapy (%BC): 84] [All Other OP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41.82] [OP Surgery  (%BC): 41.82] [Observation (%BC): 41.82] [Emergency Department (%BC): 41.82] [Occupational Therapy (%BC): 41.82] [Physical Therapy (%BC): 41.82] [Respiratory Services/Therapy  (%BC): 41.82] [Speech Therapy (%BC): 41.82] [All Other OP (%BC): 41.82]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [All OP services (%BC): 77.4] [OP Surgery  (%BC): 77.4] [Observation (%BC): 77.4] [Emergency Department (%BC): 77.4] [Occupational Therapy (%BC): 77.4] [Physical Therapy (%BC): 77.4] [Respiratory Services/Therapy  (%BC): 77.4] [Speech Therapy (%BC): 77.4] [All Other OP (%BC): 77.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41] [OP Surgery  (%BC): 41] [Observation (%BC): 41] [Emergency Department (%BC): 41] [Occupational Therapy (%BC): 41] [Physical Therapy (%BC): 41] [Respiratory Services/Therapy  (%BC): 41] [Speech Therapy (%BC): 41] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 60.6] [OP Surgery  (%BC): 60.6] [Observation (%BC): 60.6] [Emergency Department (%BC): 60.6] [Occupational Therapy (%BC): 60.6] [Physical Therapy (%BC): 60.6] [Respiratory Services/Therapy  (%BC): 60.6] [Speech Therapy (%BC): 60.6] [All Other OP (%BC): 60.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Bluecard Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [Emergency Department ($): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 79.2] [OP Surgery  (%BC): 79.2] [Observation (%BC): 79.2] [Emergency Department (%BC): 79.2] [Occupational Therapy (%BC): 79.2] [Physical Therapy (%BC): 79.2] [Respiratory Services/Therapy  (%BC): 79.2] [Speech Therapy (%BC): 79.2] [All Other OP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74] [Observation (%BC): 74] [Emergency Department (%BC): 74] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 74] [Physical Therapy (%BC): 74] [Respiratory Services/Therapy  (%BC): 74] [Speech Therapy (%BC): 74] [All Other OP (%BC): 74]","count":"1 through 10","median_amount":6048.66,"10th_percentile":6048.66,"90th_percentile":6048.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 78] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 39] [OP Surgery  (%BC): 39] [Observation (%BC): 39] [Emergency Department (%BC): 39] [Occupational Therapy (%BC): 39] [Physical Therapy (%BC): 39] [Respiratory Services/Therapy  (%BC): 39] [Speech Therapy (%BC): 39] [All Other OP (%BC): 39]","count":"1 through 10","median_amount":5368.25,"10th_percentile":5368.25,"90th_percentile":5368.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Mycare Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 75] [OP Surgery  (%BC): 75] [Observation (%BC): 75] [Emergency Department (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [All Other OP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72] [OP Surgery  (%BC): 72] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 72] [Physical Therapy (%BC): 72] [Respiratory Services/Therapy  (%BC): 72] [Speech Therapy (%BC): 72] [All Other OP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [ED Level 1--99281 ($): 27.09] [ED Level 2--99282 ($): 41.69] [ED Level 3--99283 ($): 73.69] [ED Level 4--99284 ($): 123.51] [ED Level 5--99285 ($): 223.93] [Clinic Visit ($): 59.34] [OP High Cost Drugs (%BC): 40] [Other Outpatient Implant (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":2962.72,"10th_percentile":2962.72,"90th_percentile":2962.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 Endovascular Procedures","code_information":[{"code":"5191","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 84] [OP Surgery  (%BC): 84] [Observation (%BC): 84] [Emergency Department (%BC): 84] [Occupational Therapy (%BC): 84] [Physical Therapy (%BC): 84] [Respiratory Services/Therapy  (%BC): 84] [Speech Therapy (%BC): 84] [All Other OP (%BC): 84]","count":"1 through 10","median_amount":14389.24,"10th_percentile":14389.24,"90th_percentile":14389.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41.82] [OP Surgery  (%BC): 41.82] [Observation (%BC): 41.82] [Emergency Department (%BC): 41.82] [Occupational Therapy (%BC): 41.82] [Physical Therapy (%BC): 41.82] [Respiratory Services/Therapy  (%BC): 41.82] [Speech Therapy (%BC): 41.82] [All Other OP (%BC): 41.82]","count":"1 through 10","median_amount":9743.42,"10th_percentile":6630.57,"90th_percentile":13665.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [All OP services (%BC): 77.4] [OP Surgery  (%BC): 77.4] [Observation (%BC): 77.4] [Emergency Department (%BC): 77.4] [Occupational Therapy (%BC): 77.4] [Physical Therapy (%BC): 77.4] [Respiratory Services/Therapy  (%BC): 77.4] [Speech Therapy (%BC): 77.4] [All Other OP (%BC): 77.4]","count":"15","median_amount":13658.57,"10th_percentile":12856.16,"90th_percentile":19671.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"1 through 10","median_amount":7853.47,"10th_percentile":7853.47,"90th_percentile":14714.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41] [OP Surgery  (%BC): 41] [Observation (%BC): 41] [Emergency Department (%BC): 41] [Occupational Therapy (%BC): 41] [Physical Therapy (%BC): 41] [Respiratory Services/Therapy  (%BC): 41] [Speech Therapy (%BC): 41] [All Other OP (%BC): 41]","count":"11","median_amount":6727.32,"10th_percentile":287.96,"90th_percentile":9747.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 60.6] [OP Surgery  (%BC): 60.6] [Observation (%BC): 60.6] [Emergency Department (%BC): 60.6] [Occupational Therapy (%BC): 60.6] [Physical Therapy (%BC): 60.6] [Respiratory Services/Therapy  (%BC): 60.6] [Speech Therapy (%BC): 60.6] [All Other OP (%BC): 60.6]","count":"1 through 10","median_amount":13683.26,"10th_percentile":13683.26,"90th_percentile":13683.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Bluecard Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":11230.72,"10th_percentile":11230.72,"90th_percentile":11230.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [Emergency Department ($): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":9137.42,"10th_percentile":9137.42,"90th_percentile":9137.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 79.2] [OP Surgery  (%BC): 79.2] [Observation (%BC): 79.2] [Emergency Department (%BC): 79.2] [Occupational Therapy (%BC): 79.2] [Physical Therapy (%BC): 79.2] [Respiratory Services/Therapy  (%BC): 79.2] [Speech Therapy (%BC): 79.2] [All Other OP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74] [Observation (%BC): 74] [Emergency Department (%BC): 74] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 74] [Physical Therapy (%BC): 74] [Respiratory Services/Therapy  (%BC): 74] [Speech Therapy (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 78] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 39] [OP Surgery  (%BC): 39] [Observation (%BC): 39] [Emergency Department (%BC): 39] [Occupational Therapy (%BC): 39] [Physical Therapy (%BC): 39] [Respiratory Services/Therapy  (%BC): 39] [Speech Therapy (%BC): 39] [All Other OP (%BC): 39]","count":"1 through 10","median_amount":6691.96,"10th_percentile":5917.06,"90th_percentile":7298.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"1 through 10","median_amount":17572.5,"10th_percentile":9316.0,"90th_percentile":32247.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Mycare Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 75] [OP Surgery  (%BC): 75] [Observation (%BC): 75] [Emergency Department (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [All Other OP (%BC): 75]","count":"1 through 10","median_amount":11796.68,"10th_percentile":6588.99,"90th_percentile":12904.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72] [OP Surgery  (%BC): 72] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 72] [Physical Therapy (%BC): 72] [Respiratory Services/Therapy  (%BC): 72] [Speech Therapy (%BC): 72] [All Other OP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"1 through 10","median_amount":23706.21,"10th_percentile":23706.21,"90th_percentile":23706.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"1 through 10","median_amount":14960.44,"10th_percentile":14960.44,"90th_percentile":28862.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [ED Level 1--99281 ($): 27.09] [ED Level 2--99282 ($): 41.69] [ED Level 3--99283 ($): 73.69] [ED Level 4--99284 ($): 123.51] [ED Level 5--99285 ($): 223.93] [Clinic Visit ($): 59.34] [OP High Cost Drugs (%BC): 40] [Other Outpatient Implant (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"1 through 10","median_amount":7115.26,"10th_percentile":6404.17,"90th_percentile":7714.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Endovascular Procedures","code_information":[{"code":"5192","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 84] [OP Surgery  (%BC): 84] [Observation (%BC): 84] [Emergency Department (%BC): 84] [Occupational Therapy (%BC): 84] [Physical Therapy (%BC): 84] [Respiratory Services/Therapy  (%BC): 84] [Speech Therapy (%BC): 84] [All Other OP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41.82] [OP Surgery  (%BC): 41.82] [Observation (%BC): 41.82] [Emergency Department (%BC): 41.82] [Occupational Therapy (%BC): 41.82] [Physical Therapy (%BC): 41.82] [Respiratory Services/Therapy  (%BC): 41.82] [Speech Therapy (%BC): 41.82] [All Other OP (%BC): 41.82]","count":"1 through 10","median_amount":20954.88,"10th_percentile":20954.88,"90th_percentile":20954.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [All OP services (%BC): 77.4] [OP Surgery  (%BC): 77.4] [Observation (%BC): 77.4] [Emergency Department (%BC): 77.4] [Occupational Therapy (%BC): 77.4] [Physical Therapy (%BC): 77.4] [Respiratory Services/Therapy  (%BC): 77.4] [Speech Therapy (%BC): 77.4] [All Other OP (%BC): 77.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41] [OP Surgery  (%BC): 41] [Observation (%BC): 41] [Emergency Department (%BC): 41] [Occupational Therapy (%BC): 41] [Physical Therapy (%BC): 41] [Respiratory Services/Therapy  (%BC): 41] [Speech Therapy (%BC): 41] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 60.6] [OP Surgery  (%BC): 60.6] [Observation (%BC): 60.6] [Emergency Department (%BC): 60.6] [Occupational Therapy (%BC): 60.6] [Physical Therapy (%BC): 60.6] [Respiratory Services/Therapy  (%BC): 60.6] [Speech Therapy (%BC): 60.6] [All Other OP (%BC): 60.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Bluecard Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [Emergency Department ($): 40]","count":"1 through 10","median_amount":15714.04,"10th_percentile":15714.04,"90th_percentile":15714.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 79.2] [OP Surgery  (%BC): 79.2] [Observation (%BC): 79.2] [Emergency Department (%BC): 79.2] [Occupational Therapy (%BC): 79.2] [Physical Therapy (%BC): 79.2] [Respiratory Services/Therapy  (%BC): 79.2] [Speech Therapy (%BC): 79.2] [All Other OP (%BC): 79.2]","count":"1 through 10","median_amount":47631.08,"10th_percentile":47631.08,"90th_percentile":47631.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74] [Observation (%BC): 74] [Emergency Department (%BC): 74] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 74] [Physical Therapy (%BC): 74] [Respiratory Services/Therapy  (%BC): 74] [Speech Therapy (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 78] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 39] [OP Surgery  (%BC): 39] [Observation (%BC): 39] [Emergency Department (%BC): 39] [Occupational Therapy (%BC): 39] [Physical Therapy (%BC): 39] [Respiratory Services/Therapy  (%BC): 39] [Speech Therapy (%BC): 39] [All Other OP (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Mycare Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 75] [OP Surgery  (%BC): 75] [Observation (%BC): 75] [Emergency Department (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [All Other OP (%BC): 75]","count":"1 through 10","median_amount":20121.13,"10th_percentile":20121.13,"90th_percentile":20121.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72] [OP Surgery  (%BC): 72] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 72] [Physical Therapy (%BC): 72] [Respiratory Services/Therapy  (%BC): 72] [Speech Therapy (%BC): 72] [All Other OP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [ED Level 1--99281 ($): 27.09] [ED Level 2--99282 ($): 41.69] [ED Level 3--99283 ($): 73.69] [ED Level 4--99284 ($): 123.51] [ED Level 5--99285 ($): 223.93] [Clinic Visit ($): 59.34] [OP High Cost Drugs (%BC): 40] [Other Outpatient Implant (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"1 through 10","median_amount":3482.67,"10th_percentile":3482.67,"90th_percentile":3482.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Endovascular Procedures","code_information":[{"code":"5193","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 84] [OP Surgery  (%BC): 84] [Observation (%BC): 84] [Emergency Department (%BC): 84] [Occupational Therapy (%BC): 84] [Physical Therapy (%BC): 84] [Respiratory Services/Therapy  (%BC): 84] [Speech Therapy (%BC): 84] [All Other OP (%BC): 84]","count":"1 through 10","median_amount":5998.42,"10th_percentile":5998.42,"90th_percentile":5998.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41.82] [OP Surgery  (%BC): 41.82] [Observation (%BC): 41.82] [Emergency Department (%BC): 41.82] [Occupational Therapy (%BC): 41.82] [Physical Therapy (%BC): 41.82] [Respiratory Services/Therapy  (%BC): 41.82] [Speech Therapy (%BC): 41.82] [All Other OP (%BC): 41.82]","count":"1 through 10","median_amount":15042.77,"10th_percentile":15042.77,"90th_percentile":20886.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [All OP services (%BC): 77.4] [OP Surgery  (%BC): 77.4] [Observation (%BC): 77.4] [Emergency Department (%BC): 77.4] [Occupational Therapy (%BC): 77.4] [Physical Therapy (%BC): 77.4] [Respiratory Services/Therapy  (%BC): 77.4] [Speech Therapy (%BC): 77.4] [All Other OP (%BC): 77.4]","count":"1 through 10","median_amount":21541.14,"10th_percentile":21541.14,"90th_percentile":25616.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41] [OP Surgery  (%BC): 41] [Observation (%BC): 41] [Emergency Department (%BC): 41] [Occupational Therapy (%BC): 41] [Physical Therapy (%BC): 41] [Respiratory Services/Therapy  (%BC): 41] [Speech Therapy (%BC): 41] [All Other OP (%BC): 41]","count":"1 through 10","median_amount":13212.7,"10th_percentile":9196.55,"90th_percentile":28461.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 60.6] [OP Surgery  (%BC): 60.6] [Observation (%BC): 60.6] [Emergency Department (%BC): 60.6] [Occupational Therapy (%BC): 60.6] [Physical Therapy (%BC): 60.6] [Respiratory Services/Therapy  (%BC): 60.6] [Speech Therapy (%BC): 60.6] [All Other OP (%BC): 60.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Bluecard Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":17273.0,"10th_percentile":17273.0,"90th_percentile":17273.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [Emergency Department ($): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":9693.66,"10th_percentile":9693.66,"90th_percentile":9693.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 79.2] [OP Surgery  (%BC): 79.2] [Observation (%BC): 79.2] [Emergency Department (%BC): 79.2] [Occupational Therapy (%BC): 79.2] [Physical Therapy (%BC): 79.2] [Respiratory Services/Therapy  (%BC): 79.2] [Speech Therapy (%BC): 79.2] [All Other OP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74] [Observation (%BC): 74] [Emergency Department (%BC): 74] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 74] [Physical Therapy (%BC): 74] [Respiratory Services/Therapy  (%BC): 74] [Speech Therapy (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 78] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 39] [OP Surgery  (%BC): 39] [Observation (%BC): 39] [Emergency Department (%BC): 39] [Occupational Therapy (%BC): 39] [Physical Therapy (%BC): 39] [Respiratory Services/Therapy  (%BC): 39] [Speech Therapy (%BC): 39] [All Other OP (%BC): 39]","count":"1 through 10","median_amount":5555.0,"10th_percentile":5555.0,"90th_percentile":5555.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"1 through 10","median_amount":26212.87,"10th_percentile":26212.87,"90th_percentile":30694.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Mycare Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 75] [OP Surgery  (%BC): 75] [Observation (%BC): 75] [Emergency Department (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [All Other OP (%BC): 75]","count":"1 through 10","median_amount":10501.03,"10th_percentile":10501.03,"90th_percentile":17766.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72] [OP Surgery  (%BC): 72] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 72] [Physical Therapy (%BC): 72] [Respiratory Services/Therapy  (%BC): 72] [Speech Therapy (%BC): 72] [All Other OP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"1 through 10","median_amount":7785.75,"10th_percentile":7785.75,"90th_percentile":7785.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"1 through 10","median_amount":22354.46,"10th_percentile":22354.46,"90th_percentile":22354.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [ED Level 1--99281 ($): 27.09] [ED Level 2--99282 ($): 41.69] [ED Level 3--99283 ($): 73.69] [ED Level 4--99284 ($): 123.51] [ED Level 5--99285 ($): 223.93] [Clinic Visit ($): 59.34] [OP High Cost Drugs (%BC): 40] [Other Outpatient Implant (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"1 through 10","median_amount":25871.99,"10th_percentile":25871.99,"90th_percentile":25871.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Endovascular Procedures","code_information":[{"code":"5194","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 84] [OP Surgery  (%BC): 84] [Observation (%BC): 84] [Emergency Department (%BC): 84] [Occupational Therapy (%BC): 84] [Physical Therapy (%BC): 84] [Respiratory Services/Therapy  (%BC): 84] [Speech Therapy (%BC): 84] [All Other OP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41.82] [OP Surgery  (%BC): 41.82] [Observation (%BC): 41.82] [Emergency Department (%BC): 41.82] [Occupational Therapy (%BC): 41.82] [Physical Therapy (%BC): 41.82] [Respiratory Services/Therapy  (%BC): 41.82] [Speech Therapy (%BC): 41.82] [All Other OP (%BC): 41.82]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [All OP services (%BC): 77.4] [OP Surgery  (%BC): 77.4] [Observation (%BC): 77.4] [Emergency Department (%BC): 77.4] [Occupational Therapy (%BC): 77.4] [Physical Therapy (%BC): 77.4] [Respiratory Services/Therapy  (%BC): 77.4] [Speech Therapy (%BC): 77.4] [All Other OP (%BC): 77.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41] [OP Surgery  (%BC): 41] [Observation (%BC): 41] [Emergency Department (%BC): 41] [Occupational Therapy (%BC): 41] [Physical Therapy (%BC): 41] [Respiratory Services/Therapy  (%BC): 41] [Speech Therapy (%BC): 41] [All Other OP (%BC): 41]","count":"1 through 10","median_amount":21093.49,"10th_percentile":21093.49,"90th_percentile":21093.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 60.6] [OP Surgery  (%BC): 60.6] [Observation (%BC): 60.6] [Emergency Department (%BC): 60.6] [Occupational Therapy (%BC): 60.6] [Physical Therapy (%BC): 60.6] [Respiratory Services/Therapy  (%BC): 60.6] [Speech Therapy (%BC): 60.6] [All Other OP (%BC): 60.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Bluecard Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [Emergency Department ($): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 79.2] [OP Surgery  (%BC): 79.2] [Observation (%BC): 79.2] [Emergency Department (%BC): 79.2] [Occupational Therapy (%BC): 79.2] [Physical Therapy (%BC): 79.2] [Respiratory Services/Therapy  (%BC): 79.2] [Speech Therapy (%BC): 79.2] [All Other OP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74] [Observation (%BC): 74] [Emergency Department (%BC): 74] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 74] [Physical Therapy (%BC): 74] [Respiratory Services/Therapy  (%BC): 74] [Speech Therapy (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 78] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 39] [OP Surgery  (%BC): 39] [Observation (%BC): 39] [Emergency Department (%BC): 39] [Occupational Therapy (%BC): 39] [Physical Therapy (%BC): 39] [Respiratory Services/Therapy  (%BC): 39] [Speech Therapy (%BC): 39] [All Other OP (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Mycare Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 75] [OP Surgery  (%BC): 75] [Observation (%BC): 75] [Emergency Department (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [All Other OP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72] [OP Surgery  (%BC): 72] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 72] [Physical Therapy (%BC): 72] [Respiratory Services/Therapy  (%BC): 72] [Speech Therapy (%BC): 72] [All Other OP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [ED Level 1--99281 ($): 27.09] [ED Level 2--99282 ($): 41.69] [ED Level 3--99283 ($): 73.69] [ED Level 4--99284 ($): 123.51] [ED Level 5--99285 ($): 223.93] [Clinic Visit ($): 59.34] [OP High Cost Drugs (%BC): 40] [Other Outpatient Implant (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Pacemaker and Similar Procedures","code_information":[{"code":"5222","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 84] [OP Surgery  (%BC): 84] [Observation (%BC): 84] [Emergency Department (%BC): 84] [Occupational Therapy (%BC): 84] [Physical Therapy (%BC): 84] [Respiratory Services/Therapy  (%BC): 84] [Speech Therapy (%BC): 84] [All Other OP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41.82] [OP Surgery  (%BC): 41.82] [Observation (%BC): 41.82] [Emergency Department (%BC): 41.82] [Occupational Therapy (%BC): 41.82] [Physical Therapy (%BC): 41.82] [Respiratory Services/Therapy  (%BC): 41.82] [Speech Therapy (%BC): 41.82] [All Other OP (%BC): 41.82]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [All OP services (%BC): 77.4] [OP Surgery  (%BC): 77.4] [Observation (%BC): 77.4] [Emergency Department (%BC): 77.4] [Occupational Therapy (%BC): 77.4] [Physical Therapy (%BC): 77.4] [Respiratory Services/Therapy  (%BC): 77.4] [Speech Therapy (%BC): 77.4] [All Other OP (%BC): 77.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41] [OP Surgery  (%BC): 41] [Observation (%BC): 41] [Emergency Department (%BC): 41] [Occupational Therapy (%BC): 41] [Physical Therapy (%BC): 41] [Respiratory Services/Therapy  (%BC): 41] [Speech Therapy (%BC): 41] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 60.6] [OP Surgery  (%BC): 60.6] [Observation (%BC): 60.6] [Emergency Department (%BC): 60.6] [Occupational Therapy (%BC): 60.6] [Physical Therapy (%BC): 60.6] [Respiratory Services/Therapy  (%BC): 60.6] [Speech Therapy (%BC): 60.6] [All Other OP (%BC): 60.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Bluecard Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":12580.24,"10th_percentile":12580.24,"90th_percentile":12580.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [Emergency Department ($): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 79.2] [OP Surgery  (%BC): 79.2] [Observation (%BC): 79.2] [Emergency Department (%BC): 79.2] [Occupational Therapy (%BC): 79.2] [Physical Therapy (%BC): 79.2] [Respiratory Services/Therapy  (%BC): 79.2] [Speech Therapy (%BC): 79.2] [All Other OP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74] [Observation (%BC): 74] [Emergency Department (%BC): 74] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 74] [Physical Therapy (%BC): 74] [Respiratory Services/Therapy  (%BC): 74] [Speech Therapy (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 78] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 39] [OP Surgery  (%BC): 39] [Observation (%BC): 39] [Emergency Department (%BC): 39] [Occupational Therapy (%BC): 39] [Physical Therapy (%BC): 39] [Respiratory Services/Therapy  (%BC): 39] [Speech Therapy (%BC): 39] [All Other OP (%BC): 39]","count":"1 through 10","median_amount":10761.3,"10th_percentile":10761.3,"90th_percentile":10761.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Mycare Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 75] [OP Surgery  (%BC): 75] [Observation (%BC): 75] [Emergency Department (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [All Other OP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72] [OP Surgery  (%BC): 72] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 72] [Physical Therapy (%BC): 72] [Respiratory Services/Therapy  (%BC): 72] [Speech Therapy (%BC): 72] [All Other OP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [ED Level 1--99281 ($): 27.09] [ED Level 2--99282 ($): 41.69] [ED Level 3--99283 ($): 73.69] [ED Level 4--99284 ($): 123.51] [ED Level 5--99285 ($): 223.93] [Clinic Visit ($): 59.34] [OP High Cost Drugs (%BC): 40] [Other Outpatient Implant (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"1 through 10","median_amount":10951.22,"10th_percentile":10951.22,"90th_percentile":10951.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Pacemaker and Similar Procedures","code_information":[{"code":"5223","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 84] [OP Surgery  (%BC): 84] [Observation (%BC): 84] [Emergency Department (%BC): 84] [Occupational Therapy (%BC): 84] [Physical Therapy (%BC): 84] [Respiratory Services/Therapy  (%BC): 84] [Speech Therapy (%BC): 84] [All Other OP (%BC): 84]","count":"1 through 10","median_amount":69036.69,"10th_percentile":69036.69,"90th_percentile":69036.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41.82] [OP Surgery  (%BC): 41.82] [Observation (%BC): 41.82] [Emergency Department (%BC): 41.82] [Occupational Therapy (%BC): 41.82] [Physical Therapy (%BC): 41.82] [Respiratory Services/Therapy  (%BC): 41.82] [Speech Therapy (%BC): 41.82] [All Other OP (%BC): 41.82]","count":"1 through 10","median_amount":11426.11,"10th_percentile":11426.11,"90th_percentile":11426.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [All OP services (%BC): 77.4] [OP Surgery  (%BC): 77.4] [Observation (%BC): 77.4] [Emergency Department (%BC): 77.4] [Occupational Therapy (%BC): 77.4] [Physical Therapy (%BC): 77.4] [Respiratory Services/Therapy  (%BC): 77.4] [Speech Therapy (%BC): 77.4] [All Other OP (%BC): 77.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41] [OP Surgery  (%BC): 41] [Observation (%BC): 41] [Emergency Department (%BC): 41] [Occupational Therapy (%BC): 41] [Physical Therapy (%BC): 41] [Respiratory Services/Therapy  (%BC): 41] [Speech Therapy (%BC): 41] [All Other OP (%BC): 41]","count":"1 through 10","median_amount":9816.91,"10th_percentile":9816.91,"90th_percentile":9816.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 60.6] [OP Surgery  (%BC): 60.6] [Observation (%BC): 60.6] [Emergency Department (%BC): 60.6] [Occupational Therapy (%BC): 60.6] [Physical Therapy (%BC): 60.6] [Respiratory Services/Therapy  (%BC): 60.6] [Speech Therapy (%BC): 60.6] [All Other OP (%BC): 60.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Bluecard Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [Emergency Department ($): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 79.2] [OP Surgery  (%BC): 79.2] [Observation (%BC): 79.2] [Emergency Department (%BC): 79.2] [Occupational Therapy (%BC): 79.2] [Physical Therapy (%BC): 79.2] [Respiratory Services/Therapy  (%BC): 79.2] [Speech Therapy (%BC): 79.2] [All Other OP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74] [Observation (%BC): 74] [Emergency Department (%BC): 74] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 74] [Physical Therapy (%BC): 74] [Respiratory Services/Therapy  (%BC): 74] [Speech Therapy (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 78] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 39] [OP Surgery  (%BC): 39] [Observation (%BC): 39] [Emergency Department (%BC): 39] [Occupational Therapy (%BC): 39] [Physical Therapy (%BC): 39] [Respiratory Services/Therapy  (%BC): 39] [Speech Therapy (%BC): 39] [All Other OP (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Mycare Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 75] [OP Surgery  (%BC): 75] [Observation (%BC): 75] [Emergency Department (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [All Other OP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72] [OP Surgery  (%BC): 72] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 72] [Physical Therapy (%BC): 72] [Respiratory Services/Therapy  (%BC): 72] [Speech Therapy (%BC): 72] [All Other OP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"1 through 10","median_amount":28288.38,"10th_percentile":28288.38,"90th_percentile":28288.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [ED Level 1--99281 ($): 27.09] [ED Level 2--99282 ($): 41.69] [ED Level 3--99283 ($): 73.69] [ED Level 4--99284 ($): 123.51] [ED Level 5--99285 ($): 223.93] [Clinic Visit ($): 59.34] [OP High Cost Drugs (%BC): 40] [Other Outpatient Implant (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"1 through 10","median_amount":26677.4,"10th_percentile":26677.4,"90th_percentile":26677.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 ICD and Similar Procedures","code_information":[{"code":"5231","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 84] [OP Surgery  (%BC): 84] [Observation (%BC): 84] [Emergency Department (%BC): 84] [Occupational Therapy (%BC): 84] [Physical Therapy (%BC): 84] [Respiratory Services/Therapy  (%BC): 84] [Speech Therapy (%BC): 84] [All Other OP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41.82] [OP Surgery  (%BC): 41.82] [Observation (%BC): 41.82] [Emergency Department (%BC): 41.82] [Occupational Therapy (%BC): 41.82] [Physical Therapy (%BC): 41.82] [Respiratory Services/Therapy  (%BC): 41.82] [Speech Therapy (%BC): 41.82] [All Other OP (%BC): 41.82]","count":"1 through 10","median_amount":4945.8,"10th_percentile":4945.8,"90th_percentile":4945.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [All OP services (%BC): 77.4] [OP Surgery  (%BC): 77.4] [Observation (%BC): 77.4] [Emergency Department (%BC): 77.4] [Occupational Therapy (%BC): 77.4] [Physical Therapy (%BC): 77.4] [Respiratory Services/Therapy  (%BC): 77.4] [Speech Therapy (%BC): 77.4] [All Other OP (%BC): 77.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41] [OP Surgery  (%BC): 41] [Observation (%BC): 41] [Emergency Department (%BC): 41] [Occupational Therapy (%BC): 41] [Physical Therapy (%BC): 41] [Respiratory Services/Therapy  (%BC): 41] [Speech Therapy (%BC): 41] [All Other OP (%BC): 41]","count":"1 through 10","median_amount":22843.31,"10th_percentile":22843.31,"90th_percentile":22843.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 60.6] [OP Surgery  (%BC): 60.6] [Observation (%BC): 60.6] [Emergency Department (%BC): 60.6] [Occupational Therapy (%BC): 60.6] [Physical Therapy (%BC): 60.6] [Respiratory Services/Therapy  (%BC): 60.6] [Speech Therapy (%BC): 60.6] [All Other OP (%BC): 60.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Bluecard Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [Emergency Department ($): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 79.2] [OP Surgery  (%BC): 79.2] [Observation (%BC): 79.2] [Emergency Department (%BC): 79.2] [Occupational Therapy (%BC): 79.2] [Physical Therapy (%BC): 79.2] [Respiratory Services/Therapy  (%BC): 79.2] [Speech Therapy (%BC): 79.2] [All Other OP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74] [Observation (%BC): 74] [Emergency Department (%BC): 74] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 74] [Physical Therapy (%BC): 74] [Respiratory Services/Therapy  (%BC): 74] [Speech Therapy (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 78] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 39] [OP Surgery  (%BC): 39] [Observation (%BC): 39] [Emergency Department (%BC): 39] [Occupational Therapy (%BC): 39] [Physical Therapy (%BC): 39] [Respiratory Services/Therapy  (%BC): 39] [Speech Therapy (%BC): 39] [All Other OP (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Mycare Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 75] [OP Surgery  (%BC): 75] [Observation (%BC): 75] [Emergency Department (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [All Other OP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72] [OP Surgery  (%BC): 72] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 72] [Physical Therapy (%BC): 72] [Respiratory Services/Therapy  (%BC): 72] [Speech Therapy (%BC): 72] [All Other OP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [ED Level 1--99281 ($): 27.09] [ED Level 2--99282 ($): 41.69] [ED Level 3--99283 ($): 73.69] [ED Level 4--99284 ($): 123.51] [ED Level 5--99285 ($): 223.93] [Clinic Visit ($): 59.34] [OP High Cost Drugs (%BC): 40] [Other Outpatient Implant (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 ICD and Similar Procedures","code_information":[{"code":"5232","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 84] [OP Surgery  (%BC): 84] [Observation (%BC): 84] [Emergency Department (%BC): 84] [Occupational Therapy (%BC): 84] [Physical Therapy (%BC): 84] [Respiratory Services/Therapy  (%BC): 84] [Speech Therapy (%BC): 84] [All Other OP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41.82] [OP Surgery  (%BC): 41.82] [Observation (%BC): 41.82] [Emergency Department (%BC): 41.82] [Occupational Therapy (%BC): 41.82] [Physical Therapy (%BC): 41.82] [Respiratory Services/Therapy  (%BC): 41.82] [Speech Therapy (%BC): 41.82] [All Other OP (%BC): 41.82]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [All OP services (%BC): 77.4] [OP Surgery  (%BC): 77.4] [Observation (%BC): 77.4] [Emergency Department (%BC): 77.4] [Occupational Therapy (%BC): 77.4] [Physical Therapy (%BC): 77.4] [Respiratory Services/Therapy  (%BC): 77.4] [Speech Therapy (%BC): 77.4] [All Other OP (%BC): 77.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41] [OP Surgery  (%BC): 41] [Observation (%BC): 41] [Emergency Department (%BC): 41] [Occupational Therapy (%BC): 41] [Physical Therapy (%BC): 41] [Respiratory Services/Therapy  (%BC): 41] [Speech Therapy (%BC): 41] [All Other OP (%BC): 41]","count":"1 through 10","median_amount":44711.75,"10th_percentile":44711.75,"90th_percentile":44711.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 60.6] [OP Surgery  (%BC): 60.6] [Observation (%BC): 60.6] [Emergency Department (%BC): 60.6] [Occupational Therapy (%BC): 60.6] [Physical Therapy (%BC): 60.6] [Respiratory Services/Therapy  (%BC): 60.6] [Speech Therapy (%BC): 60.6] [All Other OP (%BC): 60.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Bluecard Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [Emergency Department ($): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 79.2] [OP Surgery  (%BC): 79.2] [Observation (%BC): 79.2] [Emergency Department (%BC): 79.2] [Occupational Therapy (%BC): 79.2] [Physical Therapy (%BC): 79.2] [Respiratory Services/Therapy  (%BC): 79.2] [Speech Therapy (%BC): 79.2] [All Other OP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74] [Observation (%BC): 74] [Emergency Department (%BC): 74] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 74] [Physical Therapy (%BC): 74] [Respiratory Services/Therapy  (%BC): 74] [Speech Therapy (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 78] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 39] [OP Surgery  (%BC): 39] [Observation (%BC): 39] [Emergency Department (%BC): 39] [Occupational Therapy (%BC): 39] [Physical Therapy (%BC): 39] [Respiratory Services/Therapy  (%BC): 39] [Speech Therapy (%BC): 39] [All Other OP (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"1 through 10","median_amount":38863.18,"10th_percentile":38863.18,"90th_percentile":38863.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Mycare Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 75] [OP Surgery  (%BC): 75] [Observation (%BC): 75] [Emergency Department (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [All Other OP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72] [OP Surgery  (%BC): 72] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 72] [Physical Therapy (%BC): 72] [Respiratory Services/Therapy  (%BC): 72] [Speech Therapy (%BC): 72] [All Other OP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [ED Level 1--99281 ($): 27.09] [ED Level 2--99282 ($): 41.69] [ED Level 3--99283 ($): 73.69] [ED Level 4--99284 ($): 123.51] [ED Level 5--99285 ($): 223.93] [Clinic Visit ($): 59.34] [OP High Cost Drugs (%BC): 40] [Other Outpatient Implant (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Blood Product Exchange and Related Services","code_information":[{"code":"5241","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 84] [OP Surgery  (%BC): 84] [Observation (%BC): 84] [Emergency Department (%BC): 84] [Occupational Therapy (%BC): 84] [Physical Therapy (%BC): 84] [Respiratory Services/Therapy  (%BC): 84] [Speech Therapy (%BC): 84] [All Other OP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41.82] [OP Surgery  (%BC): 41.82] [Observation (%BC): 41.82] [Emergency Department (%BC): 41.82] [Occupational Therapy (%BC): 41.82] [Physical Therapy (%BC): 41.82] [Respiratory Services/Therapy  (%BC): 41.82] [Speech Therapy (%BC): 41.82] [All Other OP (%BC): 41.82]","count":"1 through 10","median_amount":605.89,"10th_percentile":507.87,"90th_percentile":4612.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [All OP services (%BC): 77.4] [OP Surgery  (%BC): 77.4] [Observation (%BC): 77.4] [Emergency Department (%BC): 77.4] [Occupational Therapy (%BC): 77.4] [Physical Therapy (%BC): 77.4] [Respiratory Services/Therapy  (%BC): 77.4] [Speech Therapy (%BC): 77.4] [All Other OP (%BC): 77.4]","count":"1 through 10","median_amount":2118.5,"10th_percentile":2118.5,"90th_percentile":2118.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41] [OP Surgery  (%BC): 41] [Observation (%BC): 41] [Emergency Department (%BC): 41] [Occupational Therapy (%BC): 41] [Physical Therapy (%BC): 41] [Respiratory Services/Therapy  (%BC): 41] [Speech Therapy (%BC): 41] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 60.6] [OP Surgery  (%BC): 60.6] [Observation (%BC): 60.6] [Emergency Department (%BC): 60.6] [Occupational Therapy (%BC): 60.6] [Physical Therapy (%BC): 60.6] [Respiratory Services/Therapy  (%BC): 60.6] [Speech Therapy (%BC): 60.6] [All Other OP (%BC): 60.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Bluecard Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":642.6,"10th_percentile":642.6,"90th_percentile":659.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [Emergency Department ($): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":2585.33,"10th_percentile":2585.33,"90th_percentile":2585.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 79.2] [OP Surgery  (%BC): 79.2] [Observation (%BC): 79.2] [Emergency Department (%BC): 79.2] [Occupational Therapy (%BC): 79.2] [Physical Therapy (%BC): 79.2] [Respiratory Services/Therapy  (%BC): 79.2] [Speech Therapy (%BC): 79.2] [All Other OP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74] [Observation (%BC): 74] [Emergency Department (%BC): 74] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 74] [Physical Therapy (%BC): 74] [Respiratory Services/Therapy  (%BC): 74] [Speech Therapy (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 78] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 39] [OP Surgery  (%BC): 39] [Observation (%BC): 39] [Emergency Department (%BC): 39] [Occupational Therapy (%BC): 39] [Physical Therapy (%BC): 39] [Respiratory Services/Therapy  (%BC): 39] [Speech Therapy (%BC): 39] [All Other OP (%BC): 39]","count":"11","median_amount":490.53,"10th_percentile":137.07,"90th_percentile":641.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"14","median_amount":1680.51,"10th_percentile":1171.66,"90th_percentile":1989.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Mycare Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 75] [OP Surgery  (%BC): 75] [Observation (%BC): 75] [Emergency Department (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [All Other OP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72] [OP Surgery  (%BC): 72] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 72] [Physical Therapy (%BC): 72] [Respiratory Services/Therapy  (%BC): 72] [Speech Therapy (%BC): 72] [All Other OP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"1 through 10","median_amount":2341.15,"10th_percentile":2341.15,"90th_percentile":2341.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [ED Level 1--99281 ($): 27.09] [ED Level 2--99282 ($): 41.69] [ED Level 3--99283 ($): 73.69] [ED Level 4--99284 ($): 123.51] [ED Level 5--99285 ($): 223.93] [Clinic Visit ($): 59.34] [OP High Cost Drugs (%BC): 40] [Other Outpatient Implant (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"1 through 10","median_amount":2028.81,"10th_percentile":2028.81,"90th_percentile":2028.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Upper GI Procedures","code_information":[{"code":"5301","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 84] [OP Surgery  (%BC): 84] [Observation (%BC): 84] [Emergency Department (%BC): 84] [Occupational Therapy (%BC): 84] [Physical Therapy (%BC): 84] [Respiratory Services/Therapy  (%BC): 84] [Speech Therapy (%BC): 84] [All Other OP (%BC): 84]","count":"1 through 10","median_amount":5931.26,"10th_percentile":5817.17,"90th_percentile":7472.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":2854.37,"10th_percentile":2854.37,"90th_percentile":2854.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41.82] [OP Surgery  (%BC): 41.82] [Observation (%BC): 41.82] [Emergency Department (%BC): 41.82] [Occupational Therapy (%BC): 41.82] [Physical Therapy (%BC): 41.82] [Respiratory Services/Therapy  (%BC): 41.82] [Speech Therapy (%BC): 41.82] [All Other OP (%BC): 41.82]","count":"22","median_amount":1737.45,"10th_percentile":980.23,"90th_percentile":2651.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [All OP services (%BC): 77.4] [OP Surgery  (%BC): 77.4] [Observation (%BC): 77.4] [Emergency Department (%BC): 77.4] [Occupational Therapy (%BC): 77.4] [Physical Therapy (%BC): 77.4] [Respiratory Services/Therapy  (%BC): 77.4] [Speech Therapy (%BC): 77.4] [All Other OP (%BC): 77.4]","count":"22","median_amount":4686.6,"10th_percentile":2808.0,"90th_percentile":5955.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"1 through 10","median_amount":1492.32,"10th_percentile":1422.83,"90th_percentile":8900.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41] [OP Surgery  (%BC): 41] [Observation (%BC): 41] [Emergency Department (%BC): 41] [Occupational Therapy (%BC): 41] [Physical Therapy (%BC): 41] [Respiratory Services/Therapy  (%BC): 41] [Speech Therapy (%BC): 41] [All Other OP (%BC): 41]","count":"1 through 10","median_amount":2217.26,"10th_percentile":977.99,"90th_percentile":7109.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 60.6] [OP Surgery  (%BC): 60.6] [Observation (%BC): 60.6] [Emergency Department (%BC): 60.6] [Occupational Therapy (%BC): 60.6] [Physical Therapy (%BC): 60.6] [Respiratory Services/Therapy  (%BC): 60.6] [Speech Therapy (%BC): 60.6] [All Other OP (%BC): 60.6]","count":"1 through 10","median_amount":1322.75,"10th_percentile":1060.52,"90th_percentile":5682.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Bluecard Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":4368.61,"10th_percentile":4368.61,"90th_percentile":4368.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [Emergency Department ($): 40]","count":"1 through 10","median_amount":1385.61,"10th_percentile":1214.5,"90th_percentile":1385.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":1385.61,"10th_percentile":1385.61,"90th_percentile":1385.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 79.2] [OP Surgery  (%BC): 79.2] [Observation (%BC): 79.2] [Emergency Department (%BC): 79.2] [Occupational Therapy (%BC): 79.2] [Physical Therapy (%BC): 79.2] [Respiratory Services/Therapy  (%BC): 79.2] [Speech Therapy (%BC): 79.2] [All Other OP (%BC): 79.2]","count":"1 through 10","median_amount":2612.87,"10th_percentile":2612.87,"90th_percentile":2612.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74] [Observation (%BC): 74] [Emergency Department (%BC): 74] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 74] [Physical Therapy (%BC): 74] [Respiratory Services/Therapy  (%BC): 74] [Speech Therapy (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 78] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"1 through 10","median_amount":1275.23,"10th_percentile":1275.23,"90th_percentile":1454.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 39] [OP Surgery  (%BC): 39] [Observation (%BC): 39] [Emergency Department (%BC): 39] [Occupational Therapy (%BC): 39] [Physical Therapy (%BC): 39] [Respiratory Services/Therapy  (%BC): 39] [Speech Therapy (%BC): 39] [All Other OP (%BC): 39]","count":"15","median_amount":911.83,"10th_percentile":722.84,"90th_percentile":2641.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"51","median_amount":1521.82,"10th_percentile":1401.4,"90th_percentile":3233.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Mycare Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 75] [OP Surgery  (%BC): 75] [Observation (%BC): 75] [Emergency Department (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [All Other OP (%BC): 75]","count":"1 through 10","median_amount":2687.61,"10th_percentile":2093.26,"90th_percentile":5284.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72] [OP Surgery  (%BC): 72] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 72] [Physical Therapy (%BC): 72] [Respiratory Services/Therapy  (%BC): 72] [Speech Therapy (%BC): 72] [All Other OP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"1 through 10","median_amount":6066.26,"10th_percentile":5316.46,"90th_percentile":8264.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"1 through 10","median_amount":3737.07,"10th_percentile":3737.07,"90th_percentile":5912.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [ED Level 1--99281 ($): 27.09] [ED Level 2--99282 ($): 41.69] [ED Level 3--99283 ($): 73.69] [ED Level 4--99284 ($): 123.51] [ED Level 5--99285 ($): 223.93] [Clinic Visit ($): 59.34] [OP High Cost Drugs (%BC): 40] [Other Outpatient Implant (%BC): 40]","count":"1 through 10","median_amount":1385.61,"10th_percentile":1385.61,"90th_percentile":1385.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"1 through 10","median_amount":2441.94,"10th_percentile":2199.42,"90th_percentile":4157.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":1248.15,"10th_percentile":1248.15,"90th_percentile":1248.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Upper GI Procedures","code_information":[{"code":"5302","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 84] [OP Surgery  (%BC): 84] [Observation (%BC): 84] [Emergency Department (%BC): 84] [Occupational Therapy (%BC): 84] [Physical Therapy (%BC): 84] [Respiratory Services/Therapy  (%BC): 84] [Speech Therapy (%BC): 84] [All Other OP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":2586.93,"10th_percentile":2586.93,"90th_percentile":2586.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41.82] [OP Surgery  (%BC): 41.82] [Observation (%BC): 41.82] [Emergency Department (%BC): 41.82] [Occupational Therapy (%BC): 41.82] [Physical Therapy (%BC): 41.82] [Respiratory Services/Therapy  (%BC): 41.82] [Speech Therapy (%BC): 41.82] [All Other OP (%BC): 41.82]","count":"1 through 10","median_amount":200.0,"10th_percentile":200.0,"90th_percentile":200.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [All OP services (%BC): 77.4] [OP Surgery  (%BC): 77.4] [Observation (%BC): 77.4] [Emergency Department (%BC): 77.4] [Occupational Therapy (%BC): 77.4] [Physical Therapy (%BC): 77.4] [Respiratory Services/Therapy  (%BC): 77.4] [Speech Therapy (%BC): 77.4] [All Other OP (%BC): 77.4]","count":"1 through 10","median_amount":2626.08,"10th_percentile":2626.08,"90th_percentile":9919.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"1 through 10","median_amount":8719.43,"10th_percentile":8719.43,"90th_percentile":8719.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41] [OP Surgery  (%BC): 41] [Observation (%BC): 41] [Emergency Department (%BC): 41] [Occupational Therapy (%BC): 41] [Physical Therapy (%BC): 41] [Respiratory Services/Therapy  (%BC): 41] [Speech Therapy (%BC): 41] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 60.6] [OP Surgery  (%BC): 60.6] [Observation (%BC): 60.6] [Emergency Department (%BC): 60.6] [Occupational Therapy (%BC): 60.6] [Physical Therapy (%BC): 60.6] [Respiratory Services/Therapy  (%BC): 60.6] [Speech Therapy (%BC): 60.6] [All Other OP (%BC): 60.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Bluecard Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [Emergency Department ($): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 79.2] [OP Surgery  (%BC): 79.2] [Observation (%BC): 79.2] [Emergency Department (%BC): 79.2] [Occupational Therapy (%BC): 79.2] [Physical Therapy (%BC): 79.2] [Respiratory Services/Therapy  (%BC): 79.2] [Speech Therapy (%BC): 79.2] [All Other OP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74] [Observation (%BC): 74] [Emergency Department (%BC): 74] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 74] [Physical Therapy (%BC): 74] [Respiratory Services/Therapy  (%BC): 74] [Speech Therapy (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 78] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 39] [OP Surgery  (%BC): 39] [Observation (%BC): 39] [Emergency Department (%BC): 39] [Occupational Therapy (%BC): 39] [Physical Therapy (%BC): 39] [Respiratory Services/Therapy  (%BC): 39] [Speech Therapy (%BC): 39] [All Other OP (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Mycare Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 75] [OP Surgery  (%BC): 75] [Observation (%BC): 75] [Emergency Department (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [All Other OP (%BC): 75]","count":"1 through 10","median_amount":4313.36,"10th_percentile":4313.36,"90th_percentile":4313.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72] [OP Surgery  (%BC): 72] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 72] [Physical Therapy (%BC): 72] [Respiratory Services/Therapy  (%BC): 72] [Speech Therapy (%BC): 72] [All Other OP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"1 through 10","median_amount":5683.34,"10th_percentile":5683.34,"90th_percentile":5683.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [ED Level 1--99281 ($): 27.09] [ED Level 2--99282 ($): 41.69] [ED Level 3--99283 ($): 73.69] [ED Level 4--99284 ($): 123.51] [ED Level 5--99285 ($): 223.93] [Clinic Visit ($): 59.34] [OP High Cost Drugs (%BC): 40] [Other Outpatient Implant (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"1 through 10","median_amount":9910.17,"10th_percentile":9910.17,"90th_percentile":9910.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Lower GI Procedures","code_information":[{"code":"5311","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 84] [OP Surgery  (%BC): 84] [Observation (%BC): 84] [Emergency Department (%BC): 84] [Occupational Therapy (%BC): 84] [Physical Therapy (%BC): 84] [Respiratory Services/Therapy  (%BC): 84] [Speech Therapy (%BC): 84] [All Other OP (%BC): 84]","count":"1 through 10","median_amount":3313.96,"10th_percentile":3013.03,"90th_percentile":3368.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":9435.22,"10th_percentile":9435.22,"90th_percentile":9435.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41.82] [OP Surgery  (%BC): 41.82] [Observation (%BC): 41.82] [Emergency Department (%BC): 41.82] [Occupational Therapy (%BC): 41.82] [Physical Therapy (%BC): 41.82] [Respiratory Services/Therapy  (%BC): 41.82] [Speech Therapy (%BC): 41.82] [All Other OP (%BC): 41.82]","count":"13","median_amount":1356.4,"10th_percentile":1319.61,"90th_percentile":1626.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [All OP services (%BC): 77.4] [OP Surgery  (%BC): 77.4] [Observation (%BC): 77.4] [Emergency Department (%BC): 77.4] [Occupational Therapy (%BC): 77.4] [Physical Therapy (%BC): 77.4] [Respiratory Services/Therapy  (%BC): 77.4] [Speech Therapy (%BC): 77.4] [All Other OP (%BC): 77.4]","count":"43","median_amount":2889.77,"10th_percentile":2683.56,"90th_percentile":3487.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41] [OP Surgery  (%BC): 41] [Observation (%BC): 41] [Emergency Department (%BC): 41] [Occupational Therapy (%BC): 41] [Physical Therapy (%BC): 41] [Respiratory Services/Therapy  (%BC): 41] [Speech Therapy (%BC): 41] [All Other OP (%BC): 41]","count":"1 through 10","median_amount":1343.99,"10th_percentile":1321.39,"90th_percentile":1835.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 60.6] [OP Surgery  (%BC): 60.6] [Observation (%BC): 60.6] [Emergency Department (%BC): 60.6] [Occupational Therapy (%BC): 60.6] [Physical Therapy (%BC): 60.6] [Respiratory Services/Therapy  (%BC): 60.6] [Speech Therapy (%BC): 60.6] [All Other OP (%BC): 60.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Bluecard Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":1337.95,"10th_percentile":1337.95,"90th_percentile":1337.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [Emergency Department ($): 40]","count":"1 through 10","median_amount":1339.26,"10th_percentile":1339.26,"90th_percentile":1339.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":1385.61,"10th_percentile":1385.61,"90th_percentile":1385.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 79.2] [OP Surgery  (%BC): 79.2] [Observation (%BC): 79.2] [Emergency Department (%BC): 79.2] [Occupational Therapy (%BC): 79.2] [Physical Therapy (%BC): 79.2] [Respiratory Services/Therapy  (%BC): 79.2] [Speech Therapy (%BC): 79.2] [All Other OP (%BC): 79.2]","count":"1 through 10","median_amount":3339.15,"10th_percentile":3339.15,"90th_percentile":3998.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74] [Observation (%BC): 74] [Emergency Department (%BC): 74] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 74] [Physical Therapy (%BC): 74] [Respiratory Services/Therapy  (%BC): 74] [Speech Therapy (%BC): 74] [All Other OP (%BC): 74]","count":"1 through 10","median_amount":2843.3,"10th_percentile":2843.3,"90th_percentile":2843.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 78] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"1 through 10","median_amount":1406.22,"10th_percentile":1406.22,"90th_percentile":1406.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 39] [OP Surgery  (%BC): 39] [Observation (%BC): 39] [Emergency Department (%BC): 39] [Occupational Therapy (%BC): 39] [Physical Therapy (%BC): 39] [Respiratory Services/Therapy  (%BC): 39] [Speech Therapy (%BC): 39] [All Other OP (%BC): 39]","count":"1 through 10","median_amount":1375.84,"10th_percentile":75.06,"90th_percentile":2200.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"29","median_amount":2659.36,"10th_percentile":2263.22,"90th_percentile":2878.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":1427.18,"10th_percentile":1427.18,"90th_percentile":1427.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Mycare Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"1 through 10","median_amount":3161.77,"10th_percentile":3161.77,"90th_percentile":3161.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 75] [OP Surgery  (%BC): 75] [Observation (%BC): 75] [Emergency Department (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [All Other OP (%BC): 75]","count":"12","median_amount":2023.43,"10th_percentile":1329.6,"90th_percentile":5530.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72] [OP Surgery  (%BC): 72] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 72] [Physical Therapy (%BC): 72] [Respiratory Services/Therapy  (%BC): 72] [Speech Therapy (%BC): 72] [All Other OP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"1 through 10","median_amount":3198.24,"10th_percentile":3016.94,"90th_percentile":3612.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"1 through 10","median_amount":3618.49,"10th_percentile":3618.49,"90th_percentile":3646.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [ED Level 1--99281 ($): 27.09] [ED Level 2--99282 ($): 41.69] [ED Level 3--99283 ($): 73.69] [ED Level 4--99284 ($): 123.51] [ED Level 5--99285 ($): 223.93] [Clinic Visit ($): 59.34] [OP High Cost Drugs (%BC): 40] [Other Outpatient Implant (%BC): 40]","count":"1 through 10","median_amount":1385.61,"10th_percentile":1385.61,"90th_percentile":1385.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"1 through 10","median_amount":3191.16,"10th_percentile":1892.18,"90th_percentile":3692.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":6271.16,"10th_percentile":6271.16,"90th_percentile":6271.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Lower GI Procedures","code_information":[{"code":"5312","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 84] [OP Surgery  (%BC): 84] [Observation (%BC): 84] [Emergency Department (%BC): 84] [Occupational Therapy (%BC): 84] [Physical Therapy (%BC): 84] [Respiratory Services/Therapy  (%BC): 84] [Speech Therapy (%BC): 84] [All Other OP (%BC): 84]","count":"1 through 10","median_amount":4179.58,"10th_percentile":3308.1,"90th_percentile":7760.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":1745.84,"10th_percentile":1745.84,"90th_percentile":1745.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41.82] [OP Surgery  (%BC): 41.82] [Observation (%BC): 41.82] [Emergency Department (%BC): 41.82] [Occupational Therapy (%BC): 41.82] [Physical Therapy (%BC): 41.82] [Respiratory Services/Therapy  (%BC): 41.82] [Speech Therapy (%BC): 41.82] [All Other OP (%BC): 41.82]","count":"24","median_amount":1726.79,"10th_percentile":1490.79,"90th_percentile":3134.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [All OP services (%BC): 77.4] [OP Surgery  (%BC): 77.4] [Observation (%BC): 77.4] [Emergency Department (%BC): 77.4] [Occupational Therapy (%BC): 77.4] [Physical Therapy (%BC): 77.4] [Respiratory Services/Therapy  (%BC): 77.4] [Speech Therapy (%BC): 77.4] [All Other OP (%BC): 77.4]","count":"56","median_amount":3491.06,"10th_percentile":1385.61,"90th_percentile":6158.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"1 through 10","median_amount":2741.13,"10th_percentile":2600.64,"90th_percentile":4398.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41] [OP Surgery  (%BC): 41] [Observation (%BC): 41] [Emergency Department (%BC): 41] [Occupational Therapy (%BC): 41] [Physical Therapy (%BC): 41] [Respiratory Services/Therapy  (%BC): 41] [Speech Therapy (%BC): 41] [All Other OP (%BC): 41]","count":"12","median_amount":2859.29,"10th_percentile":1702.81,"90th_percentile":3190.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 60.6] [OP Surgery  (%BC): 60.6] [Observation (%BC): 60.6] [Emergency Department (%BC): 60.6] [Occupational Therapy (%BC): 60.6] [Physical Therapy (%BC): 60.6] [Respiratory Services/Therapy  (%BC): 60.6] [Speech Therapy (%BC): 60.6] [All Other OP (%BC): 60.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Bluecard Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":2137.15,"10th_percentile":1629.48,"90th_percentile":3587.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [Emergency Department ($): 40]","count":"1 through 10","median_amount":1385.61,"10th_percentile":1385.61,"90th_percentile":2078.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 79.2] [OP Surgery  (%BC): 79.2] [Observation (%BC): 79.2] [Emergency Department (%BC): 79.2] [Occupational Therapy (%BC): 79.2] [Physical Therapy (%BC): 79.2] [Respiratory Services/Therapy  (%BC): 79.2] [Speech Therapy (%BC): 79.2] [All Other OP (%BC): 79.2]","count":"1 through 10","median_amount":3434.17,"10th_percentile":3434.17,"90th_percentile":3434.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74] [Observation (%BC): 74] [Emergency Department (%BC): 74] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 74] [Physical Therapy (%BC): 74] [Respiratory Services/Therapy  (%BC): 74] [Speech Therapy (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 78] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"1 through 10","median_amount":1454.89,"10th_percentile":1454.89,"90th_percentile":1454.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 39] [OP Surgery  (%BC): 39] [Observation (%BC): 39] [Emergency Department (%BC): 39] [Occupational Therapy (%BC): 39] [Physical Therapy (%BC): 39] [Respiratory Services/Therapy  (%BC): 39] [Speech Therapy (%BC): 39] [All Other OP (%BC): 39]","count":"13","median_amount":1556.8,"10th_percentile":938.22,"90th_percentile":2339.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"32","median_amount":3102.06,"10th_percentile":2547.49,"90th_percentile":5683.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Mycare Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 75] [OP Surgery  (%BC): 75] [Observation (%BC): 75] [Emergency Department (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [All Other OP (%BC): 75]","count":"16","median_amount":2983.1,"10th_percentile":1523.87,"90th_percentile":3979.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72] [OP Surgery  (%BC): 72] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 72] [Physical Therapy (%BC): 72] [Respiratory Services/Therapy  (%BC): 72] [Speech Therapy (%BC): 72] [All Other OP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"1 through 10","median_amount":1672.14,"10th_percentile":1672.14,"90th_percentile":1672.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"1 through 10","median_amount":3744.48,"10th_percentile":3719.69,"90th_percentile":7719.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"1 through 10","median_amount":6709.02,"10th_percentile":6709.02,"90th_percentile":6709.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [ED Level 1--99281 ($): 27.09] [ED Level 2--99282 ($): 41.69] [ED Level 3--99283 ($): 73.69] [ED Level 4--99284 ($): 123.51] [ED Level 5--99285 ($): 223.93] [Clinic Visit ($): 59.34] [OP High Cost Drugs (%BC): 40] [Other Outpatient Implant (%BC): 40]","count":"1 through 10","median_amount":1385.61,"10th_percentile":1385.61,"90th_percentile":2078.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"1 through 10","median_amount":3201.47,"10th_percentile":1561.34,"90th_percentile":7245.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":1551.47,"10th_percentile":1551.47,"90th_percentile":1551.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Lower GI Procedures","code_information":[{"code":"5313","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 84] [OP Surgery  (%BC): 84] [Observation (%BC): 84] [Emergency Department (%BC): 84] [Occupational Therapy (%BC): 84] [Physical Therapy (%BC): 84] [Respiratory Services/Therapy  (%BC): 84] [Speech Therapy (%BC): 84] [All Other OP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41.82] [OP Surgery  (%BC): 41.82] [Observation (%BC): 41.82] [Emergency Department (%BC): 41.82] [Occupational Therapy (%BC): 41.82] [Physical Therapy (%BC): 41.82] [Respiratory Services/Therapy  (%BC): 41.82] [Speech Therapy (%BC): 41.82] [All Other OP (%BC): 41.82]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [All OP services (%BC): 77.4] [OP Surgery  (%BC): 77.4] [Observation (%BC): 77.4] [Emergency Department (%BC): 77.4] [Occupational Therapy (%BC): 77.4] [Physical Therapy (%BC): 77.4] [Respiratory Services/Therapy  (%BC): 77.4] [Speech Therapy (%BC): 77.4] [All Other OP (%BC): 77.4]","count":"1 through 10","median_amount":7431.74,"10th_percentile":7431.74,"90th_percentile":7431.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41] [OP Surgery  (%BC): 41] [Observation (%BC): 41] [Emergency Department (%BC): 41] [Occupational Therapy (%BC): 41] [Physical Therapy (%BC): 41] [Respiratory Services/Therapy  (%BC): 41] [Speech Therapy (%BC): 41] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 60.6] [OP Surgery  (%BC): 60.6] [Observation (%BC): 60.6] [Emergency Department (%BC): 60.6] [Occupational Therapy (%BC): 60.6] [Physical Therapy (%BC): 60.6] [Respiratory Services/Therapy  (%BC): 60.6] [Speech Therapy (%BC): 60.6] [All Other OP (%BC): 60.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Bluecard Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [Emergency Department ($): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 79.2] [OP Surgery  (%BC): 79.2] [Observation (%BC): 79.2] [Emergency Department (%BC): 79.2] [Occupational Therapy (%BC): 79.2] [Physical Therapy (%BC): 79.2] [Respiratory Services/Therapy  (%BC): 79.2] [Speech Therapy (%BC): 79.2] [All Other OP (%BC): 79.2]","count":"1 through 10","median_amount":10003.1,"10th_percentile":10003.1,"90th_percentile":10003.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74] [Observation (%BC): 74] [Emergency Department (%BC): 74] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 74] [Physical Therapy (%BC): 74] [Respiratory Services/Therapy  (%BC): 74] [Speech Therapy (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 78] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"1 through 10","median_amount":3001.62,"10th_percentile":3001.62,"90th_percentile":3001.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 39] [OP Surgery  (%BC): 39] [Observation (%BC): 39] [Emergency Department (%BC): 39] [Occupational Therapy (%BC): 39] [Physical Therapy (%BC): 39] [Respiratory Services/Therapy  (%BC): 39] [Speech Therapy (%BC): 39] [All Other OP (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Mycare Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 75] [OP Surgery  (%BC): 75] [Observation (%BC): 75] [Emergency Department (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [All Other OP (%BC): 75]","count":"1 through 10","median_amount":3934.25,"10th_percentile":3934.25,"90th_percentile":3934.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72] [OP Surgery  (%BC): 72] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 72] [Physical Therapy (%BC): 72] [Respiratory Services/Therapy  (%BC): 72] [Speech Therapy (%BC): 72] [All Other OP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [ED Level 1--99281 ($): 27.09] [ED Level 2--99282 ($): 41.69] [ED Level 3--99283 ($): 73.69] [ED Level 4--99284 ($): 123.51] [ED Level 5--99285 ($): 223.93] [Clinic Visit ($): 59.34] [OP High Cost Drugs (%BC): 40] [Other Outpatient Implant (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"1 through 10","median_amount":3336.9,"10th_percentile":3336.9,"90th_percentile":3336.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Abdominal/Peritoneal/Biliary and Related Procedures","code_information":[{"code":"5341","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 84] [OP Surgery  (%BC): 84] [Observation (%BC): 84] [Emergency Department (%BC): 84] [Occupational Therapy (%BC): 84] [Physical Therapy (%BC): 84] [Respiratory Services/Therapy  (%BC): 84] [Speech Therapy (%BC): 84] [All Other OP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41.82] [OP Surgery  (%BC): 41.82] [Observation (%BC): 41.82] [Emergency Department (%BC): 41.82] [Occupational Therapy (%BC): 41.82] [Physical Therapy (%BC): 41.82] [Respiratory Services/Therapy  (%BC): 41.82] [Speech Therapy (%BC): 41.82] [All Other OP (%BC): 41.82]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [All OP services (%BC): 77.4] [OP Surgery  (%BC): 77.4] [Observation (%BC): 77.4] [Emergency Department (%BC): 77.4] [Occupational Therapy (%BC): 77.4] [Physical Therapy (%BC): 77.4] [Respiratory Services/Therapy  (%BC): 77.4] [Speech Therapy (%BC): 77.4] [All Other OP (%BC): 77.4]","count":"1 through 10","median_amount":7537.9,"10th_percentile":6552.01,"90th_percentile":21163.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41] [OP Surgery  (%BC): 41] [Observation (%BC): 41] [Emergency Department (%BC): 41] [Occupational Therapy (%BC): 41] [Physical Therapy (%BC): 41] [Respiratory Services/Therapy  (%BC): 41] [Speech Therapy (%BC): 41] [All Other OP (%BC): 41]","count":"1 through 10","median_amount":6553.05,"10th_percentile":6553.05,"90th_percentile":6553.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 60.6] [OP Surgery  (%BC): 60.6] [Observation (%BC): 60.6] [Emergency Department (%BC): 60.6] [Occupational Therapy (%BC): 60.6] [Physical Therapy (%BC): 60.6] [Respiratory Services/Therapy  (%BC): 60.6] [Speech Therapy (%BC): 60.6] [All Other OP (%BC): 60.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Bluecard Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [Emergency Department ($): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 79.2] [OP Surgery  (%BC): 79.2] [Observation (%BC): 79.2] [Emergency Department (%BC): 79.2] [Occupational Therapy (%BC): 79.2] [Physical Therapy (%BC): 79.2] [Respiratory Services/Therapy  (%BC): 79.2] [Speech Therapy (%BC): 79.2] [All Other OP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74] [Observation (%BC): 74] [Emergency Department (%BC): 74] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 74] [Physical Therapy (%BC): 74] [Respiratory Services/Therapy  (%BC): 74] [Speech Therapy (%BC): 74] [All Other OP (%BC): 74]","count":"1 through 10","median_amount":2550.41,"10th_percentile":2550.41,"90th_percentile":2550.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 78] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"1 through 10","median_amount":5543.95,"10th_percentile":5543.95,"90th_percentile":5543.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 39] [OP Surgery  (%BC): 39] [Observation (%BC): 39] [Emergency Department (%BC): 39] [Occupational Therapy (%BC): 39] [Physical Therapy (%BC): 39] [Respiratory Services/Therapy  (%BC): 39] [Speech Therapy (%BC): 39] [All Other OP (%BC): 39]","count":"1 through 10","median_amount":671.31,"10th_percentile":671.31,"90th_percentile":671.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"1 through 10","median_amount":5872.26,"10th_percentile":5872.26,"90th_percentile":5872.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":1912.34,"10th_percentile":1912.34,"90th_percentile":1912.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Mycare Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 75] [OP Surgery  (%BC): 75] [Observation (%BC): 75] [Emergency Department (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [All Other OP (%BC): 75]","count":"1 through 10","median_amount":1511.2,"10th_percentile":1511.2,"90th_percentile":1511.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72] [OP Surgery  (%BC): 72] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 72] [Physical Therapy (%BC): 72] [Respiratory Services/Therapy  (%BC): 72] [Speech Therapy (%BC): 72] [All Other OP (%BC): 72]","count":"1 through 10","median_amount":14018.77,"10th_percentile":14018.77,"90th_percentile":14018.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"1 through 10","median_amount":24705.8,"10th_percentile":24705.8,"90th_percentile":24705.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [ED Level 1--99281 ($): 27.09] [ED Level 2--99282 ($): 41.69] [ED Level 3--99283 ($): 73.69] [ED Level 4--99284 ($): 123.51] [ED Level 5--99285 ($): 223.93] [Clinic Visit ($): 59.34] [OP High Cost Drugs (%BC): 40] [Other Outpatient Implant (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"1 through 10","median_amount":8042.8,"10th_percentile":8042.8,"90th_percentile":8042.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Abdominal/Peritoneal/Biliary and Related Procedures","code_information":[{"code":"5342","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 84] [OP Surgery  (%BC): 84] [Observation (%BC): 84] [Emergency Department (%BC): 84] [Occupational Therapy (%BC): 84] [Physical Therapy (%BC): 84] [Respiratory Services/Therapy  (%BC): 84] [Speech Therapy (%BC): 84] [All Other OP (%BC): 84]","count":"1 through 10","median_amount":1527.74,"10th_percentile":1527.74,"90th_percentile":1527.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41.82] [OP Surgery  (%BC): 41.82] [Observation (%BC): 41.82] [Emergency Department (%BC): 41.82] [Occupational Therapy (%BC): 41.82] [Physical Therapy (%BC): 41.82] [Respiratory Services/Therapy  (%BC): 41.82] [Speech Therapy (%BC): 41.82] [All Other OP (%BC): 41.82]","count":"1 through 10","median_amount":7655.31,"10th_percentile":7655.31,"90th_percentile":7655.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [All OP services (%BC): 77.4] [OP Surgery  (%BC): 77.4] [Observation (%BC): 77.4] [Emergency Department (%BC): 77.4] [Occupational Therapy (%BC): 77.4] [Physical Therapy (%BC): 77.4] [Respiratory Services/Therapy  (%BC): 77.4] [Speech Therapy (%BC): 77.4] [All Other OP (%BC): 77.4]","count":"1 through 10","median_amount":11504.97,"10th_percentile":11504.97,"90th_percentile":11504.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41] [OP Surgery  (%BC): 41] [Observation (%BC): 41] [Emergency Department (%BC): 41] [Occupational Therapy (%BC): 41] [Physical Therapy (%BC): 41] [Respiratory Services/Therapy  (%BC): 41] [Speech Therapy (%BC): 41] [All Other OP (%BC): 41]","count":"1 through 10","median_amount":6135.56,"10th_percentile":6135.56,"90th_percentile":6135.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 60.6] [OP Surgery  (%BC): 60.6] [Observation (%BC): 60.6] [Emergency Department (%BC): 60.6] [Occupational Therapy (%BC): 60.6] [Physical Therapy (%BC): 60.6] [Respiratory Services/Therapy  (%BC): 60.6] [Speech Therapy (%BC): 60.6] [All Other OP (%BC): 60.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Bluecard Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [Emergency Department ($): 40]","count":"1 through 10","median_amount":5723.43,"10th_percentile":5723.43,"90th_percentile":5723.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 79.2] [OP Surgery  (%BC): 79.2] [Observation (%BC): 79.2] [Emergency Department (%BC): 79.2] [Occupational Therapy (%BC): 79.2] [Physical Therapy (%BC): 79.2] [Respiratory Services/Therapy  (%BC): 79.2] [Speech Therapy (%BC): 79.2] [All Other OP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74] [Observation (%BC): 74] [Emergency Department (%BC): 74] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 74] [Physical Therapy (%BC): 74] [Respiratory Services/Therapy  (%BC): 74] [Speech Therapy (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 78] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 39] [OP Surgery  (%BC): 39] [Observation (%BC): 39] [Emergency Department (%BC): 39] [Occupational Therapy (%BC): 39] [Physical Therapy (%BC): 39] [Respiratory Services/Therapy  (%BC): 39] [Speech Therapy (%BC): 39] [All Other OP (%BC): 39]","count":"1 through 10","median_amount":10593.59,"10th_percentile":10593.59,"90th_percentile":10593.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"1 through 10","median_amount":9177.93,"10th_percentile":8447.99,"90th_percentile":13842.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Mycare Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 75] [OP Surgery  (%BC): 75] [Observation (%BC): 75] [Emergency Department (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [All Other OP (%BC): 75]","count":"1 through 10","median_amount":9861.25,"10th_percentile":9861.25,"90th_percentile":9861.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72] [OP Surgery  (%BC): 72] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 72] [Physical Therapy (%BC): 72] [Respiratory Services/Therapy  (%BC): 72] [Speech Therapy (%BC): 72] [All Other OP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"1 through 10","median_amount":8876.42,"10th_percentile":8876.42,"90th_percentile":8876.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [ED Level 1--99281 ($): 27.09] [ED Level 2--99282 ($): 41.69] [ED Level 3--99283 ($): 73.69] [ED Level 4--99284 ($): 123.51] [ED Level 5--99285 ($): 223.93] [Clinic Visit ($): 59.34] [OP High Cost Drugs (%BC): 40] [Other Outpatient Implant (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":6086.57,"10th_percentile":6086.57,"90th_percentile":6086.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 Laparoscopy and Related Services","code_information":[{"code":"5361","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 84] [OP Surgery  (%BC): 84] [Observation (%BC): 84] [Emergency Department (%BC): 84] [Occupational Therapy (%BC): 84] [Physical Therapy (%BC): 84] [Respiratory Services/Therapy  (%BC): 84] [Speech Therapy (%BC): 84] [All Other OP (%BC): 84]","count":"1 through 10","median_amount":12841.79,"10th_percentile":12841.79,"90th_percentile":12841.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":6950.28,"10th_percentile":6950.28,"90th_percentile":6950.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41.82] [OP Surgery  (%BC): 41.82] [Observation (%BC): 41.82] [Emergency Department (%BC): 41.82] [Occupational Therapy (%BC): 41.82] [Physical Therapy (%BC): 41.82] [Respiratory Services/Therapy  (%BC): 41.82] [Speech Therapy (%BC): 41.82] [All Other OP (%BC): 41.82]","count":"1 through 10","median_amount":6452.07,"10th_percentile":6140.53,"90th_percentile":7723.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [All OP services (%BC): 77.4] [OP Surgery  (%BC): 77.4] [Observation (%BC): 77.4] [Emergency Department (%BC): 77.4] [Occupational Therapy (%BC): 77.4] [Physical Therapy (%BC): 77.4] [Respiratory Services/Therapy  (%BC): 77.4] [Speech Therapy (%BC): 77.4] [All Other OP (%BC): 77.4]","count":"28","median_amount":13229.75,"10th_percentile":7384.05,"90th_percentile":15660.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41] [OP Surgery  (%BC): 41] [Observation (%BC): 41] [Emergency Department (%BC): 41] [Occupational Therapy (%BC): 41] [Physical Therapy (%BC): 41] [Respiratory Services/Therapy  (%BC): 41] [Speech Therapy (%BC): 41] [All Other OP (%BC): 41]","count":"1 through 10","median_amount":5655.18,"10th_percentile":5540.14,"90th_percentile":11282.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 60.6] [OP Surgery  (%BC): 60.6] [Observation (%BC): 60.6] [Emergency Department (%BC): 60.6] [Occupational Therapy (%BC): 60.6] [Physical Therapy (%BC): 60.6] [Respiratory Services/Therapy  (%BC): 60.6] [Speech Therapy (%BC): 60.6] [All Other OP (%BC): 60.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Bluecard Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [Emergency Department ($): 40]","count":"1 through 10","median_amount":5214.45,"10th_percentile":4705.21,"90th_percentile":6994.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 79.2] [OP Surgery  (%BC): 79.2] [Observation (%BC): 79.2] [Emergency Department (%BC): 79.2] [Occupational Therapy (%BC): 79.2] [Physical Therapy (%BC): 79.2] [Respiratory Services/Therapy  (%BC): 79.2] [Speech Therapy (%BC): 79.2] [All Other OP (%BC): 79.2]","count":"1 through 10","median_amount":14317.36,"10th_percentile":14317.36,"90th_percentile":14317.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74] [Observation (%BC): 74] [Emergency Department (%BC): 74] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 74] [Physical Therapy (%BC): 74] [Respiratory Services/Therapy  (%BC): 74] [Speech Therapy (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 78] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"1 through 10","median_amount":4940.47,"10th_percentile":4940.47,"90th_percentile":4940.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 39] [OP Surgery  (%BC): 39] [Observation (%BC): 39] [Emergency Department (%BC): 39] [Occupational Therapy (%BC): 39] [Physical Therapy (%BC): 39] [Respiratory Services/Therapy  (%BC): 39] [Speech Therapy (%BC): 39] [All Other OP (%BC): 39]","count":"1 through 10","median_amount":6671.59,"10th_percentile":6668.97,"90th_percentile":6913.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"12","median_amount":12873.61,"10th_percentile":11184.55,"90th_percentile":20538.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Mycare Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 75] [OP Surgery  (%BC): 75] [Observation (%BC): 75] [Emergency Department (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [All Other OP (%BC): 75]","count":"1 through 10","median_amount":5563.77,"10th_percentile":1420.45,"90th_percentile":11584.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72] [OP Surgery  (%BC): 72] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 72] [Physical Therapy (%BC): 72] [Respiratory Services/Therapy  (%BC): 72] [Speech Therapy (%BC): 72] [All Other OP (%BC): 72]","count":"1 through 10","median_amount":14201.09,"10th_percentile":14201.09,"90th_percentile":14201.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"1 through 10","median_amount":14246.25,"10th_percentile":14246.25,"90th_percentile":14246.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [ED Level 1--99281 ($): 27.09] [ED Level 2--99282 ($): 41.69] [ED Level 3--99283 ($): 73.69] [ED Level 4--99284 ($): 123.51] [ED Level 5--99285 ($): 223.93] [Clinic Visit ($): 59.34] [OP High Cost Drugs (%BC): 40] [Other Outpatient Implant (%BC): 40]","count":"1 through 10","median_amount":6503.68,"10th_percentile":6503.68,"90th_percentile":6503.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"1 through 10","median_amount":5643.5,"10th_percentile":5643.5,"90th_percentile":7395.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Laparoscopy and Related Services","code_information":[{"code":"5362","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 84] [OP Surgery  (%BC): 84] [Observation (%BC): 84] [Emergency Department (%BC): 84] [Occupational Therapy (%BC): 84] [Physical Therapy (%BC): 84] [Respiratory Services/Therapy  (%BC): 84] [Speech Therapy (%BC): 84] [All Other OP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41.82] [OP Surgery  (%BC): 41.82] [Observation (%BC): 41.82] [Emergency Department (%BC): 41.82] [Occupational Therapy (%BC): 41.82] [Physical Therapy (%BC): 41.82] [Respiratory Services/Therapy  (%BC): 41.82] [Speech Therapy (%BC): 41.82] [All Other OP (%BC): 41.82]","count":"1 through 10","median_amount":9797.92,"10th_percentile":9797.92,"90th_percentile":9797.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [All OP services (%BC): 77.4] [OP Surgery  (%BC): 77.4] [Observation (%BC): 77.4] [Emergency Department (%BC): 77.4] [Occupational Therapy (%BC): 77.4] [Physical Therapy (%BC): 77.4] [Respiratory Services/Therapy  (%BC): 77.4] [Speech Therapy (%BC): 77.4] [All Other OP (%BC): 77.4]","count":"1 through 10","median_amount":13916.28,"10th_percentile":13916.28,"90th_percentile":13916.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"1 through 10","median_amount":6350.06,"10th_percentile":6350.06,"90th_percentile":6350.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41] [OP Surgery  (%BC): 41] [Observation (%BC): 41] [Emergency Department (%BC): 41] [Occupational Therapy (%BC): 41] [Physical Therapy (%BC): 41] [Respiratory Services/Therapy  (%BC): 41] [Speech Therapy (%BC): 41] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 60.6] [OP Surgery  (%BC): 60.6] [Observation (%BC): 60.6] [Emergency Department (%BC): 60.6] [Occupational Therapy (%BC): 60.6] [Physical Therapy (%BC): 60.6] [Respiratory Services/Therapy  (%BC): 60.6] [Speech Therapy (%BC): 60.6] [All Other OP (%BC): 60.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Bluecard Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [Emergency Department ($): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 79.2] [OP Surgery  (%BC): 79.2] [Observation (%BC): 79.2] [Emergency Department (%BC): 79.2] [Occupational Therapy (%BC): 79.2] [Physical Therapy (%BC): 79.2] [Respiratory Services/Therapy  (%BC): 79.2] [Speech Therapy (%BC): 79.2] [All Other OP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74] [Observation (%BC): 74] [Emergency Department (%BC): 74] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 74] [Physical Therapy (%BC): 74] [Respiratory Services/Therapy  (%BC): 74] [Speech Therapy (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 78] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 39] [OP Surgery  (%BC): 39] [Observation (%BC): 39] [Emergency Department (%BC): 39] [Occupational Therapy (%BC): 39] [Physical Therapy (%BC): 39] [Respiratory Services/Therapy  (%BC): 39] [Speech Therapy (%BC): 39] [All Other OP (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Mycare Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 75] [OP Surgery  (%BC): 75] [Observation (%BC): 75] [Emergency Department (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [All Other OP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72] [OP Surgery  (%BC): 72] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 72] [Physical Therapy (%BC): 72] [Respiratory Services/Therapy  (%BC): 72] [Speech Therapy (%BC): 72] [All Other OP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [ED Level 1--99281 ($): 27.09] [ED Level 2--99282 ($): 41.69] [ED Level 3--99283 ($): 73.69] [ED Level 4--99284 ($): 123.51] [ED Level 5--99285 ($): 223.93] [Clinic Visit ($): 59.34] [OP High Cost Drugs (%BC): 40] [Other Outpatient Implant (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Urology and Related Services","code_information":[{"code":"5371","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 84] [OP Surgery  (%BC): 84] [Observation (%BC): 84] [Emergency Department (%BC): 84] [Occupational Therapy (%BC): 84] [Physical Therapy (%BC): 84] [Respiratory Services/Therapy  (%BC): 84] [Speech Therapy (%BC): 84] [All Other OP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41.82] [OP Surgery  (%BC): 41.82] [Observation (%BC): 41.82] [Emergency Department (%BC): 41.82] [Occupational Therapy (%BC): 41.82] [Physical Therapy (%BC): 41.82] [Respiratory Services/Therapy  (%BC): 41.82] [Speech Therapy (%BC): 41.82] [All Other OP (%BC): 41.82]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [All OP services (%BC): 77.4] [OP Surgery  (%BC): 77.4] [Observation (%BC): 77.4] [Emergency Department (%BC): 77.4] [Occupational Therapy (%BC): 77.4] [Physical Therapy (%BC): 77.4] [Respiratory Services/Therapy  (%BC): 77.4] [Speech Therapy (%BC): 77.4] [All Other OP (%BC): 77.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41] [OP Surgery  (%BC): 41] [Observation (%BC): 41] [Emergency Department (%BC): 41] [Occupational Therapy (%BC): 41] [Physical Therapy (%BC): 41] [Respiratory Services/Therapy  (%BC): 41] [Speech Therapy (%BC): 41] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 60.6] [OP Surgery  (%BC): 60.6] [Observation (%BC): 60.6] [Emergency Department (%BC): 60.6] [Occupational Therapy (%BC): 60.6] [Physical Therapy (%BC): 60.6] [Respiratory Services/Therapy  (%BC): 60.6] [Speech Therapy (%BC): 60.6] [All Other OP (%BC): 60.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Bluecard Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [Emergency Department ($): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 79.2] [OP Surgery  (%BC): 79.2] [Observation (%BC): 79.2] [Emergency Department (%BC): 79.2] [Occupational Therapy (%BC): 79.2] [Physical Therapy (%BC): 79.2] [Respiratory Services/Therapy  (%BC): 79.2] [Speech Therapy (%BC): 79.2] [All Other OP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74] [Observation (%BC): 74] [Emergency Department (%BC): 74] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 74] [Physical Therapy (%BC): 74] [Respiratory Services/Therapy  (%BC): 74] [Speech Therapy (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 78] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 39] [OP Surgery  (%BC): 39] [Observation (%BC): 39] [Emergency Department (%BC): 39] [Occupational Therapy (%BC): 39] [Physical Therapy (%BC): 39] [Respiratory Services/Therapy  (%BC): 39] [Speech Therapy (%BC): 39] [All Other OP (%BC): 39]","count":"1 through 10","median_amount":42.35,"10th_percentile":42.35,"90th_percentile":42.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Mycare Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 75] [OP Surgery  (%BC): 75] [Observation (%BC): 75] [Emergency Department (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [All Other OP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72] [OP Surgery  (%BC): 72] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 72] [Physical Therapy (%BC): 72] [Respiratory Services/Therapy  (%BC): 72] [Speech Therapy (%BC): 72] [All Other OP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [ED Level 1--99281 ($): 27.09] [ED Level 2--99282 ($): 41.69] [ED Level 3--99283 ($): 73.69] [ED Level 4--99284 ($): 123.51] [ED Level 5--99285 ($): 223.93] [Clinic Visit ($): 59.34] [OP High Cost Drugs (%BC): 40] [Other Outpatient Implant (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Urology and Related Services","code_information":[{"code":"5372","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 84] [OP Surgery  (%BC): 84] [Observation (%BC): 84] [Emergency Department (%BC): 84] [Occupational Therapy (%BC): 84] [Physical Therapy (%BC): 84] [Respiratory Services/Therapy  (%BC): 84] [Speech Therapy (%BC): 84] [All Other OP (%BC): 84]","count":"1 through 10","median_amount":4155.97,"10th_percentile":4155.97,"90th_percentile":4155.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":1570.99,"10th_percentile":1570.99,"90th_percentile":1570.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41.82] [OP Surgery  (%BC): 41.82] [Observation (%BC): 41.82] [Emergency Department (%BC): 41.82] [Occupational Therapy (%BC): 41.82] [Physical Therapy (%BC): 41.82] [Respiratory Services/Therapy  (%BC): 41.82] [Speech Therapy (%BC): 41.82] [All Other OP (%BC): 41.82]","count":"20","median_amount":1590.04,"10th_percentile":49.24,"90th_percentile":2624.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [All OP services (%BC): 77.4] [OP Surgery  (%BC): 77.4] [Observation (%BC): 77.4] [Emergency Department (%BC): 77.4] [Occupational Therapy (%BC): 77.4] [Physical Therapy (%BC): 77.4] [Respiratory Services/Therapy  (%BC): 77.4] [Speech Therapy (%BC): 77.4] [All Other OP (%BC): 77.4]","count":"11","median_amount":3400.77,"10th_percentile":1659.89,"90th_percentile":4653.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"1 through 10","median_amount":1725.76,"10th_percentile":1725.76,"90th_percentile":1725.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41] [OP Surgery  (%BC): 41] [Observation (%BC): 41] [Emergency Department (%BC): 41] [Occupational Therapy (%BC): 41] [Physical Therapy (%BC): 41] [Respiratory Services/Therapy  (%BC): 41] [Speech Therapy (%BC): 41] [All Other OP (%BC): 41]","count":"11","median_amount":1491.79,"10th_percentile":45.57,"90th_percentile":2241.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 60.6] [OP Surgery  (%BC): 60.6] [Observation (%BC): 60.6] [Emergency Department (%BC): 60.6] [Occupational Therapy (%BC): 60.6] [Physical Therapy (%BC): 60.6] [Respiratory Services/Therapy  (%BC): 60.6] [Speech Therapy (%BC): 60.6] [All Other OP (%BC): 60.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Bluecard Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":1547.92,"10th_percentile":1547.92,"90th_percentile":1547.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [Emergency Department ($): 40]","count":"1 through 10","median_amount":1659.89,"10th_percentile":1659.89,"90th_percentile":1659.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 79.2] [OP Surgery  (%BC): 79.2] [Observation (%BC): 79.2] [Emergency Department (%BC): 79.2] [Occupational Therapy (%BC): 79.2] [Physical Therapy (%BC): 79.2] [Respiratory Services/Therapy  (%BC): 79.2] [Speech Therapy (%BC): 79.2] [All Other OP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74] [Observation (%BC): 74] [Emergency Department (%BC): 74] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 74] [Physical Therapy (%BC): 74] [Respiratory Services/Therapy  (%BC): 74] [Speech Therapy (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 78] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 39] [OP Surgery  (%BC): 39] [Observation (%BC): 39] [Emergency Department (%BC): 39] [Occupational Therapy (%BC): 39] [Physical Therapy (%BC): 39] [Respiratory Services/Therapy  (%BC): 39] [Speech Therapy (%BC): 39] [All Other OP (%BC): 39]","count":"11","median_amount":610.97,"10th_percentile":514.35,"90th_percentile":1831.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"1 through 10","median_amount":3674.86,"10th_percentile":3094.0,"90th_percentile":4865.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Mycare Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 75] [OP Surgery  (%BC): 75] [Observation (%BC): 75] [Emergency Department (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [All Other OP (%BC): 75]","count":"1 through 10","median_amount":1522.04,"10th_percentile":47.3,"90th_percentile":1915.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72] [OP Surgery  (%BC): 72] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 72] [Physical Therapy (%BC): 72] [Respiratory Services/Therapy  (%BC): 72] [Speech Therapy (%BC): 72] [All Other OP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"1 through 10","median_amount":4314.84,"10th_percentile":4314.84,"90th_percentile":4314.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"1 through 10","median_amount":4330.45,"10th_percentile":4330.45,"90th_percentile":7828.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [ED Level 1--99281 ($): 27.09] [ED Level 2--99282 ($): 41.69] [ED Level 3--99283 ($): 73.69] [ED Level 4--99284 ($): 123.51] [ED Level 5--99285 ($): 223.93] [Clinic Visit ($): 59.34] [OP High Cost Drugs (%BC): 40] [Other Outpatient Implant (%BC): 40]","count":"1 through 10","median_amount":1659.89,"10th_percentile":1659.89,"90th_percentile":1659.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"1 through 10","median_amount":4395.75,"10th_percentile":4395.75,"90th_percentile":4395.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Urology and Related Services","code_information":[{"code":"5373","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 84] [OP Surgery  (%BC): 84] [Observation (%BC): 84] [Emergency Department (%BC): 84] [Occupational Therapy (%BC): 84] [Physical Therapy (%BC): 84] [Respiratory Services/Therapy  (%BC): 84] [Speech Therapy (%BC): 84] [All Other OP (%BC): 84]","count":"1 through 10","median_amount":6541.76,"10th_percentile":6273.65,"90th_percentile":7285.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":3481.18,"10th_percentile":3481.18,"90th_percentile":3481.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41.82] [OP Surgery  (%BC): 41.82] [Observation (%BC): 41.82] [Emergency Department (%BC): 41.82] [Occupational Therapy (%BC): 41.82] [Physical Therapy (%BC): 41.82] [Respiratory Services/Therapy  (%BC): 41.82] [Speech Therapy (%BC): 41.82] [All Other OP (%BC): 41.82]","count":"17","median_amount":3266.26,"10th_percentile":2967.39,"90th_percentile":4220.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [All OP services (%BC): 77.4] [OP Surgery  (%BC): 77.4] [Observation (%BC): 77.4] [Emergency Department (%BC): 77.4] [Occupational Therapy (%BC): 77.4] [Physical Therapy (%BC): 77.4] [Respiratory Services/Therapy  (%BC): 77.4] [Speech Therapy (%BC): 77.4] [All Other OP (%BC): 77.4]","count":"24","median_amount":6170.14,"10th_percentile":4142.76,"90th_percentile":7351.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"1 through 10","median_amount":3134.36,"10th_percentile":3134.36,"90th_percentile":3150.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41] [OP Surgery  (%BC): 41] [Observation (%BC): 41] [Emergency Department (%BC): 41] [Occupational Therapy (%BC): 41] [Physical Therapy (%BC): 41] [Respiratory Services/Therapy  (%BC): 41] [Speech Therapy (%BC): 41] [All Other OP (%BC): 41]","count":"11","median_amount":2857.85,"10th_percentile":655.15,"90th_percentile":3621.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 60.6] [OP Surgery  (%BC): 60.6] [Observation (%BC): 60.6] [Emergency Department (%BC): 60.6] [Occupational Therapy (%BC): 60.6] [Physical Therapy (%BC): 60.6] [Respiratory Services/Therapy  (%BC): 60.6] [Speech Therapy (%BC): 60.6] [All Other OP (%BC): 60.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Bluecard Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [Emergency Department ($): 40]","count":"1 through 10","median_amount":1856.64,"10th_percentile":1856.64,"90th_percentile":3287.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":1659.89,"10th_percentile":1659.89,"90th_percentile":1659.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 79.2] [OP Surgery  (%BC): 79.2] [Observation (%BC): 79.2] [Emergency Department (%BC): 79.2] [Occupational Therapy (%BC): 79.2] [Physical Therapy (%BC): 79.2] [Respiratory Services/Therapy  (%BC): 79.2] [Speech Therapy (%BC): 79.2] [All Other OP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74] [Observation (%BC): 74] [Emergency Department (%BC): 74] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 74] [Physical Therapy (%BC): 74] [Respiratory Services/Therapy  (%BC): 74] [Speech Therapy (%BC): 74] [All Other OP (%BC): 74]","count":"1 through 10","median_amount":5240.85,"10th_percentile":5240.85,"90th_percentile":5240.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 78] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"1 through 10","median_amount":1742.88,"10th_percentile":1742.88,"90th_percentile":1742.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 39] [OP Surgery  (%BC): 39] [Observation (%BC): 39] [Emergency Department (%BC): 39] [Occupational Therapy (%BC): 39] [Physical Therapy (%BC): 39] [Respiratory Services/Therapy  (%BC): 39] [Speech Therapy (%BC): 39] [All Other OP (%BC): 39]","count":"1 through 10","median_amount":1925.3,"10th_percentile":604.36,"90th_percentile":3232.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"1 through 10","median_amount":6473.37,"10th_percentile":5693.33,"90th_percentile":8137.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Mycare Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 75] [OP Surgery  (%BC): 75] [Observation (%BC): 75] [Emergency Department (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [All Other OP (%BC): 75]","count":"12","median_amount":3381.03,"10th_percentile":2865.67,"90th_percentile":6900.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72] [OP Surgery  (%BC): 72] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 72] [Physical Therapy (%BC): 72] [Respiratory Services/Therapy  (%BC): 72] [Speech Therapy (%BC): 72] [All Other OP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"1 through 10","median_amount":8273.21,"10th_percentile":7690.49,"90th_percentile":12278.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"1 through 10","median_amount":8827.07,"10th_percentile":8827.07,"90th_percentile":8827.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [ED Level 1--99281 ($): 27.09] [ED Level 2--99282 ($): 41.69] [ED Level 3--99283 ($): 73.69] [ED Level 4--99284 ($): 123.51] [ED Level 5--99285 ($): 223.93] [Clinic Visit ($): 59.34] [OP High Cost Drugs (%BC): 40] [Other Outpatient Implant (%BC): 40]","count":"1 through 10","median_amount":1659.89,"10th_percentile":1604.36,"90th_percentile":1659.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"1 through 10","median_amount":5254.92,"10th_percentile":3884.4,"90th_percentile":9234.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Urology and Related Services","code_information":[{"code":"5374","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 84] [OP Surgery  (%BC): 84] [Observation (%BC): 84] [Emergency Department (%BC): 84] [Occupational Therapy (%BC): 84] [Physical Therapy (%BC): 84] [Respiratory Services/Therapy  (%BC): 84] [Speech Therapy (%BC): 84] [All Other OP (%BC): 84]","count":"1 through 10","median_amount":12626.67,"10th_percentile":12626.67,"90th_percentile":12626.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":1095.8,"10th_percentile":1095.8,"90th_percentile":1095.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41.82] [OP Surgery  (%BC): 41.82] [Observation (%BC): 41.82] [Emergency Department (%BC): 41.82] [Occupational Therapy (%BC): 41.82] [Physical Therapy (%BC): 41.82] [Respiratory Services/Therapy  (%BC): 41.82] [Speech Therapy (%BC): 41.82] [All Other OP (%BC): 41.82]","count":"12","median_amount":3969.97,"10th_percentile":3567.82,"90th_percentile":6216.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [All OP services (%BC): 77.4] [OP Surgery  (%BC): 77.4] [Observation (%BC): 77.4] [Emergency Department (%BC): 77.4] [Occupational Therapy (%BC): 77.4] [Physical Therapy (%BC): 77.4] [Respiratory Services/Therapy  (%BC): 77.4] [Speech Therapy (%BC): 77.4] [All Other OP (%BC): 77.4]","count":"32","median_amount":10762.7,"10th_percentile":3295.49,"90th_percentile":12272.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"1 through 10","median_amount":5572.93,"10th_percentile":5572.93,"90th_percentile":5572.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41] [OP Surgery  (%BC): 41] [Observation (%BC): 41] [Emergency Department (%BC): 41] [Occupational Therapy (%BC): 41] [Physical Therapy (%BC): 41] [Respiratory Services/Therapy  (%BC): 41] [Speech Therapy (%BC): 41] [All Other OP (%BC): 41]","count":"1 through 10","median_amount":3397.16,"10th_percentile":3215.75,"90th_percentile":5656.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 60.6] [OP Surgery  (%BC): 60.6] [Observation (%BC): 60.6] [Emergency Department (%BC): 60.6] [Occupational Therapy (%BC): 60.6] [Physical Therapy (%BC): 60.6] [Respiratory Services/Therapy  (%BC): 60.6] [Speech Therapy (%BC): 60.6] [All Other OP (%BC): 60.6]","count":"1 through 10","median_amount":6284.68,"10th_percentile":6284.68,"90th_percentile":6284.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Bluecard Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":3500.14,"10th_percentile":3500.14,"90th_percentile":3500.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [Emergency Department ($): 40]","count":"1 through 10","median_amount":3295.49,"10th_percentile":3052.97,"90th_percentile":3313.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":3185.24,"10th_percentile":3185.24,"90th_percentile":3185.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 79.2] [OP Surgery  (%BC): 79.2] [Observation (%BC): 79.2] [Emergency Department (%BC): 79.2] [Occupational Therapy (%BC): 79.2] [Physical Therapy (%BC): 79.2] [Respiratory Services/Therapy  (%BC): 79.2] [Speech Therapy (%BC): 79.2] [All Other OP (%BC): 79.2]","count":"1 through 10","median_amount":12101.75,"10th_percentile":12101.75,"90th_percentile":12101.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74] [Observation (%BC): 74] [Emergency Department (%BC): 74] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 74] [Physical Therapy (%BC): 74] [Respiratory Services/Therapy  (%BC): 74] [Speech Therapy (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 78] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"1 through 10","median_amount":3460.26,"10th_percentile":3460.26,"90th_percentile":3460.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 39] [OP Surgery  (%BC): 39] [Observation (%BC): 39] [Emergency Department (%BC): 39] [Occupational Therapy (%BC): 39] [Physical Therapy (%BC): 39] [Respiratory Services/Therapy  (%BC): 39] [Speech Therapy (%BC): 39] [All Other OP (%BC): 39]","count":"1 through 10","median_amount":1497.59,"10th_percentile":685.46,"90th_percentile":3441.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"1 through 10","median_amount":8380.68,"10th_percentile":6489.53,"90th_percentile":11178.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Mycare Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 75] [OP Surgery  (%BC): 75] [Observation (%BC): 75] [Emergency Department (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [All Other OP (%BC): 75]","count":"1 through 10","median_amount":5487.45,"10th_percentile":4405.89,"90th_percentile":8165.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72] [OP Surgery  (%BC): 72] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 72] [Physical Therapy (%BC): 72] [Respiratory Services/Therapy  (%BC): 72] [Speech Therapy (%BC): 72] [All Other OP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"1 through 10","median_amount":13206.52,"10th_percentile":13206.52,"90th_percentile":13206.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"1 through 10","median_amount":6397.42,"10th_percentile":6397.42,"90th_percentile":6397.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [ED Level 1--99281 ($): 27.09] [ED Level 2--99282 ($): 41.69] [ED Level 3--99283 ($): 73.69] [ED Level 4--99284 ($): 123.51] [ED Level 5--99285 ($): 223.93] [Clinic Visit ($): 59.34] [OP High Cost Drugs (%BC): 40] [Other Outpatient Implant (%BC): 40]","count":"1 through 10","median_amount":777.76,"10th_percentile":777.76,"90th_percentile":777.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"1 through 10","median_amount":5021.91,"10th_percentile":5021.91,"90th_percentile":5021.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 5 Urology and Related Services","code_information":[{"code":"5375","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 84] [OP Surgery  (%BC): 84] [Observation (%BC): 84] [Emergency Department (%BC): 84] [Occupational Therapy (%BC): 84] [Physical Therapy (%BC): 84] [Respiratory Services/Therapy  (%BC): 84] [Speech Therapy (%BC): 84] [All Other OP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":4779.47,"10th_percentile":4779.47,"90th_percentile":4779.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41.82] [OP Surgery  (%BC): 41.82] [Observation (%BC): 41.82] [Emergency Department (%BC): 41.82] [Occupational Therapy (%BC): 41.82] [Physical Therapy (%BC): 41.82] [Respiratory Services/Therapy  (%BC): 41.82] [Speech Therapy (%BC): 41.82] [All Other OP (%BC): 41.82]","count":"1 through 10","median_amount":4822.94,"10th_percentile":4050.69,"90th_percentile":8166.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [All OP services (%BC): 77.4] [OP Surgery  (%BC): 77.4] [Observation (%BC): 77.4] [Emergency Department (%BC): 77.4] [Occupational Therapy (%BC): 77.4] [Physical Therapy (%BC): 77.4] [Respiratory Services/Therapy  (%BC): 77.4] [Speech Therapy (%BC): 77.4] [All Other OP (%BC): 77.4]","count":"15","median_amount":10021.52,"10th_percentile":8866.86,"90th_percentile":18642.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41] [OP Surgery  (%BC): 41] [Observation (%BC): 41] [Emergency Department (%BC): 41] [Occupational Therapy (%BC): 41] [Physical Therapy (%BC): 41] [Respiratory Services/Therapy  (%BC): 41] [Speech Therapy (%BC): 41] [All Other OP (%BC): 41]","count":"1 through 10","median_amount":4502.44,"10th_percentile":4449.89,"90th_percentile":7000.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 60.6] [OP Surgery  (%BC): 60.6] [Observation (%BC): 60.6] [Emergency Department (%BC): 60.6] [Occupational Therapy (%BC): 60.6] [Physical Therapy (%BC): 60.6] [Respiratory Services/Therapy  (%BC): 60.6] [Speech Therapy (%BC): 60.6] [All Other OP (%BC): 60.6]","count":"1 through 10","median_amount":10399.23,"10th_percentile":10399.23,"90th_percentile":10399.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Bluecard Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":4413.48,"10th_percentile":4413.48,"90th_percentile":4413.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [Emergency Department ($): 40]","count":"1 through 10","median_amount":5112.56,"10th_percentile":4408.33,"90th_percentile":5190.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 79.2] [OP Surgery  (%BC): 79.2] [Observation (%BC): 79.2] [Emergency Department (%BC): 79.2] [Occupational Therapy (%BC): 79.2] [Physical Therapy (%BC): 79.2] [Respiratory Services/Therapy  (%BC): 79.2] [Speech Therapy (%BC): 79.2] [All Other OP (%BC): 79.2]","count":"1 through 10","median_amount":18144.21,"10th_percentile":18144.21,"90th_percentile":18144.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74] [Observation (%BC): 74] [Emergency Department (%BC): 74] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 74] [Physical Therapy (%BC): 74] [Respiratory Services/Therapy  (%BC): 74] [Speech Therapy (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 78] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"1 through 10","median_amount":4628.75,"10th_percentile":4628.75,"90th_percentile":4628.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 39] [OP Surgery  (%BC): 39] [Observation (%BC): 39] [Emergency Department (%BC): 39] [Occupational Therapy (%BC): 39] [Physical Therapy (%BC): 39] [Respiratory Services/Therapy  (%BC): 39] [Speech Therapy (%BC): 39] [All Other OP (%BC): 39]","count":"1 through 10","median_amount":5053.72,"10th_percentile":4064.59,"90th_percentile":8471.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"11","median_amount":8296.48,"10th_percentile":6256.16,"90th_percentile":10868.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Mycare Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 75] [OP Surgery  (%BC): 75] [Observation (%BC): 75] [Emergency Department (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [All Other OP (%BC): 75]","count":"1 through 10","median_amount":6905.53,"10th_percentile":3823.13,"90th_percentile":13165.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72] [OP Surgery  (%BC): 72] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 72] [Physical Therapy (%BC): 72] [Respiratory Services/Therapy  (%BC): 72] [Speech Therapy (%BC): 72] [All Other OP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [ED Level 1--99281 ($): 27.09] [ED Level 2--99282 ($): 41.69] [ED Level 3--99283 ($): 73.69] [ED Level 4--99284 ($): 123.51] [ED Level 5--99285 ($): 223.93] [Clinic Visit ($): 59.34] [OP High Cost Drugs (%BC): 40] [Other Outpatient Implant (%BC): 40]","count":"1 through 10","median_amount":4408.33,"10th_percentile":4408.33,"90th_percentile":4408.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"1 through 10","median_amount":7634.52,"10th_percentile":6621.81,"90th_percentile":10923.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 6 Urology and Related Services","code_information":[{"code":"5376","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 84] [OP Surgery  (%BC): 84] [Observation (%BC): 84] [Emergency Department (%BC): 84] [Occupational Therapy (%BC): 84] [Physical Therapy (%BC): 84] [Respiratory Services/Therapy  (%BC): 84] [Speech Therapy (%BC): 84] [All Other OP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41.82] [OP Surgery  (%BC): 41.82] [Observation (%BC): 41.82] [Emergency Department (%BC): 41.82] [Occupational Therapy (%BC): 41.82] [Physical Therapy (%BC): 41.82] [Respiratory Services/Therapy  (%BC): 41.82] [Speech Therapy (%BC): 41.82] [All Other OP (%BC): 41.82]","count":"1 through 10","median_amount":7085.88,"10th_percentile":7085.88,"90th_percentile":7085.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [All OP services (%BC): 77.4] [OP Surgery  (%BC): 77.4] [Observation (%BC): 77.4] [Emergency Department (%BC): 77.4] [Occupational Therapy (%BC): 77.4] [Physical Therapy (%BC): 77.4] [Respiratory Services/Therapy  (%BC): 77.4] [Speech Therapy (%BC): 77.4] [All Other OP (%BC): 77.4]","count":"1 through 10","median_amount":14730.05,"10th_percentile":13433.63,"90th_percentile":16245.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41] [OP Surgery  (%BC): 41] [Observation (%BC): 41] [Emergency Department (%BC): 41] [Occupational Therapy (%BC): 41] [Physical Therapy (%BC): 41] [Respiratory Services/Therapy  (%BC): 41] [Speech Therapy (%BC): 41] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 60.6] [OP Surgery  (%BC): 60.6] [Observation (%BC): 60.6] [Emergency Department (%BC): 60.6] [Occupational Therapy (%BC): 60.6] [Physical Therapy (%BC): 60.6] [Respiratory Services/Therapy  (%BC): 60.6] [Speech Therapy (%BC): 60.6] [All Other OP (%BC): 60.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Bluecard Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [Emergency Department ($): 40]","count":"1 through 10","median_amount":3295.49,"10th_percentile":3295.49,"90th_percentile":3295.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 79.2] [OP Surgery  (%BC): 79.2] [Observation (%BC): 79.2] [Emergency Department (%BC): 79.2] [Occupational Therapy (%BC): 79.2] [Physical Therapy (%BC): 79.2] [Respiratory Services/Therapy  (%BC): 79.2] [Speech Therapy (%BC): 79.2] [All Other OP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74] [Observation (%BC): 74] [Emergency Department (%BC): 74] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 74] [Physical Therapy (%BC): 74] [Respiratory Services/Therapy  (%BC): 74] [Speech Therapy (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 78] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"1 through 10","median_amount":3460.26,"10th_percentile":3460.26,"90th_percentile":3460.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 39] [OP Surgery  (%BC): 39] [Observation (%BC): 39] [Emergency Department (%BC): 39] [Occupational Therapy (%BC): 39] [Physical Therapy (%BC): 39] [Respiratory Services/Therapy  (%BC): 39] [Speech Therapy (%BC): 39] [All Other OP (%BC): 39]","count":"1 through 10","median_amount":6808.5,"10th_percentile":6808.5,"90th_percentile":6808.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Mycare Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 75] [OP Surgery  (%BC): 75] [Observation (%BC): 75] [Emergency Department (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [All Other OP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72] [OP Surgery  (%BC): 72] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 72] [Physical Therapy (%BC): 72] [Respiratory Services/Therapy  (%BC): 72] [Speech Therapy (%BC): 72] [All Other OP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [ED Level 1--99281 ($): 27.09] [ED Level 2--99282 ($): 41.69] [ED Level 3--99283 ($): 73.69] [ED Level 4--99284 ($): 123.51] [ED Level 5--99285 ($): 223.93] [Clinic Visit ($): 59.34] [OP High Cost Drugs (%BC): 40] [Other Outpatient Implant (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Gynecologic Procedures","code_information":[{"code":"5411","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 84] [OP Surgery  (%BC): 84] [Observation (%BC): 84] [Emergency Department (%BC): 84] [Occupational Therapy (%BC): 84] [Physical Therapy (%BC): 84] [Respiratory Services/Therapy  (%BC): 84] [Speech Therapy (%BC): 84] [All Other OP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41.82] [OP Surgery  (%BC): 41.82] [Observation (%BC): 41.82] [Emergency Department (%BC): 41.82] [Occupational Therapy (%BC): 41.82] [Physical Therapy (%BC): 41.82] [Respiratory Services/Therapy  (%BC): 41.82] [Speech Therapy (%BC): 41.82] [All Other OP (%BC): 41.82]","count":"1 through 10","median_amount":23.91,"10th_percentile":23.91,"90th_percentile":23.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [All OP services (%BC): 77.4] [OP Surgery  (%BC): 77.4] [Observation (%BC): 77.4] [Emergency Department (%BC): 77.4] [Occupational Therapy (%BC): 77.4] [Physical Therapy (%BC): 77.4] [Respiratory Services/Therapy  (%BC): 77.4] [Speech Therapy (%BC): 77.4] [All Other OP (%BC): 77.4]","count":"35","median_amount":260.24,"10th_percentile":184.44,"90th_percentile":815.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41] [OP Surgery  (%BC): 41] [Observation (%BC): 41] [Emergency Department (%BC): 41] [Occupational Therapy (%BC): 41] [Physical Therapy (%BC): 41] [Respiratory Services/Therapy  (%BC): 41] [Speech Therapy (%BC): 41] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 60.6] [OP Surgery  (%BC): 60.6] [Observation (%BC): 60.6] [Emergency Department (%BC): 60.6] [Occupational Therapy (%BC): 60.6] [Physical Therapy (%BC): 60.6] [Respiratory Services/Therapy  (%BC): 60.6] [Speech Therapy (%BC): 60.6] [All Other OP (%BC): 60.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Bluecard Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [Emergency Department ($): 40]","count":"25","median_amount":363.9,"10th_percentile":249.39,"90th_percentile":466.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":410.54,"10th_percentile":410.54,"90th_percentile":410.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 79.2] [OP Surgery  (%BC): 79.2] [Observation (%BC): 79.2] [Emergency Department (%BC): 79.2] [Occupational Therapy (%BC): 79.2] [Physical Therapy (%BC): 79.2] [Respiratory Services/Therapy  (%BC): 79.2] [Speech Therapy (%BC): 79.2] [All Other OP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74] [Observation (%BC): 74] [Emergency Department (%BC): 74] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 74] [Physical Therapy (%BC): 74] [Respiratory Services/Therapy  (%BC): 74] [Speech Therapy (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 78] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"15","median_amount":346.14,"10th_percentile":233.77,"90th_percentile":747.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 39] [OP Surgery  (%BC): 39] [Observation (%BC): 39] [Emergency Department (%BC): 39] [Occupational Therapy (%BC): 39] [Physical Therapy (%BC): 39] [Respiratory Services/Therapy  (%BC): 39] [Speech Therapy (%BC): 39] [All Other OP (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"1 through 10","median_amount":263.75,"10th_percentile":171.82,"90th_percentile":508.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Mycare Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 75] [OP Surgery  (%BC): 75] [Observation (%BC): 75] [Emergency Department (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [All Other OP (%BC): 75]","count":"1 through 10","median_amount":174.49,"10th_percentile":174.49,"90th_percentile":174.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72] [OP Surgery  (%BC): 72] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 72] [Physical Therapy (%BC): 72] [Respiratory Services/Therapy  (%BC): 72] [Speech Therapy (%BC): 72] [All Other OP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"1 through 10","median_amount":191.9,"10th_percentile":191.9,"90th_percentile":618.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [ED Level 1--99281 ($): 27.09] [ED Level 2--99282 ($): 41.69] [ED Level 3--99283 ($): 73.69] [ED Level 4--99284 ($): 123.51] [ED Level 5--99285 ($): 223.93] [Clinic Visit ($): 59.34] [OP High Cost Drugs (%BC): 40] [Other Outpatient Implant (%BC): 40]","count":"1 through 10","median_amount":431.08,"10th_percentile":431.08,"90th_percentile":533.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Gynecologic Procedures","code_information":[{"code":"5412","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 84] [OP Surgery  (%BC): 84] [Observation (%BC): 84] [Emergency Department (%BC): 84] [Occupational Therapy (%BC): 84] [Physical Therapy (%BC): 84] [Respiratory Services/Therapy  (%BC): 84] [Speech Therapy (%BC): 84] [All Other OP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41.82] [OP Surgery  (%BC): 41.82] [Observation (%BC): 41.82] [Emergency Department (%BC): 41.82] [Occupational Therapy (%BC): 41.82] [Physical Therapy (%BC): 41.82] [Respiratory Services/Therapy  (%BC): 41.82] [Speech Therapy (%BC): 41.82] [All Other OP (%BC): 41.82]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [All OP services (%BC): 77.4] [OP Surgery  (%BC): 77.4] [Observation (%BC): 77.4] [Emergency Department (%BC): 77.4] [Occupational Therapy (%BC): 77.4] [Physical Therapy (%BC): 77.4] [Respiratory Services/Therapy  (%BC): 77.4] [Speech Therapy (%BC): 77.4] [All Other OP (%BC): 77.4]","count":"1 through 10","median_amount":318.92,"10th_percentile":318.92,"90th_percentile":318.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41] [OP Surgery  (%BC): 41] [Observation (%BC): 41] [Emergency Department (%BC): 41] [Occupational Therapy (%BC): 41] [Physical Therapy (%BC): 41] [Respiratory Services/Therapy  (%BC): 41] [Speech Therapy (%BC): 41] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 60.6] [OP Surgery  (%BC): 60.6] [Observation (%BC): 60.6] [Emergency Department (%BC): 60.6] [Occupational Therapy (%BC): 60.6] [Physical Therapy (%BC): 60.6] [Respiratory Services/Therapy  (%BC): 60.6] [Speech Therapy (%BC): 60.6] [All Other OP (%BC): 60.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Bluecard Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [Emergency Department ($): 40]","count":"1 through 10","median_amount":30.94,"10th_percentile":30.94,"90th_percentile":30.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 79.2] [OP Surgery  (%BC): 79.2] [Observation (%BC): 79.2] [Emergency Department (%BC): 79.2] [Occupational Therapy (%BC): 79.2] [Physical Therapy (%BC): 79.2] [Respiratory Services/Therapy  (%BC): 79.2] [Speech Therapy (%BC): 79.2] [All Other OP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74] [Observation (%BC): 74] [Emergency Department (%BC): 74] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 74] [Physical Therapy (%BC): 74] [Respiratory Services/Therapy  (%BC): 74] [Speech Therapy (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 78] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 39] [OP Surgery  (%BC): 39] [Observation (%BC): 39] [Emergency Department (%BC): 39] [Occupational Therapy (%BC): 39] [Physical Therapy (%BC): 39] [Respiratory Services/Therapy  (%BC): 39] [Speech Therapy (%BC): 39] [All Other OP (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"1 through 10","median_amount":4218.25,"10th_percentile":4218.25,"90th_percentile":4218.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Mycare Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 75] [OP Surgery  (%BC): 75] [Observation (%BC): 75] [Emergency Department (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [All Other OP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72] [OP Surgery  (%BC): 72] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 72] [Physical Therapy (%BC): 72] [Respiratory Services/Therapy  (%BC): 72] [Speech Therapy (%BC): 72] [All Other OP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [ED Level 1--99281 ($): 27.09] [ED Level 2--99282 ($): 41.69] [ED Level 3--99283 ($): 73.69] [ED Level 4--99284 ($): 123.51] [ED Level 5--99285 ($): 223.93] [Clinic Visit ($): 59.34] [OP High Cost Drugs (%BC): 40] [Other Outpatient Implant (%BC): 40]","count":"1 through 10","median_amount":38.31,"10th_percentile":38.31,"90th_percentile":38.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Gynecologic Procedures","code_information":[{"code":"5414","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 84] [OP Surgery  (%BC): 84] [Observation (%BC): 84] [Emergency Department (%BC): 84] [Occupational Therapy (%BC): 84] [Physical Therapy (%BC): 84] [Respiratory Services/Therapy  (%BC): 84] [Speech Therapy (%BC): 84] [All Other OP (%BC): 84]","count":"1 through 10","median_amount":5501.31,"10th_percentile":5501.31,"90th_percentile":5501.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41.82] [OP Surgery  (%BC): 41.82] [Observation (%BC): 41.82] [Emergency Department (%BC): 41.82] [Occupational Therapy (%BC): 41.82] [Physical Therapy (%BC): 41.82] [Respiratory Services/Therapy  (%BC): 41.82] [Speech Therapy (%BC): 41.82] [All Other OP (%BC): 41.82]","count":"1 through 10","median_amount":3584.86,"10th_percentile":3584.86,"90th_percentile":3584.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [All OP services (%BC): 77.4] [OP Surgery  (%BC): 77.4] [Observation (%BC): 77.4] [Emergency Department (%BC): 77.4] [Occupational Therapy (%BC): 77.4] [Physical Therapy (%BC): 77.4] [Respiratory Services/Therapy  (%BC): 77.4] [Speech Therapy (%BC): 77.4] [All Other OP (%BC): 77.4]","count":"1 through 10","median_amount":6503.73,"10th_percentile":6400.93,"90th_percentile":7432.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41] [OP Surgery  (%BC): 41] [Observation (%BC): 41] [Emergency Department (%BC): 41] [Occupational Therapy (%BC): 41] [Physical Therapy (%BC): 41] [Respiratory Services/Therapy  (%BC): 41] [Speech Therapy (%BC): 41] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 60.6] [OP Surgery  (%BC): 60.6] [Observation (%BC): 60.6] [Emergency Department (%BC): 60.6] [Occupational Therapy (%BC): 60.6] [Physical Therapy (%BC): 60.6] [Respiratory Services/Therapy  (%BC): 60.6] [Speech Therapy (%BC): 60.6] [All Other OP (%BC): 60.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Bluecard Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [Emergency Department ($): 40]","count":"1 through 10","median_amount":2563.34,"10th_percentile":2563.34,"90th_percentile":2563.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 79.2] [OP Surgery  (%BC): 79.2] [Observation (%BC): 79.2] [Emergency Department (%BC): 79.2] [Occupational Therapy (%BC): 79.2] [Physical Therapy (%BC): 79.2] [Respiratory Services/Therapy  (%BC): 79.2] [Speech Therapy (%BC): 79.2] [All Other OP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74] [Observation (%BC): 74] [Emergency Department (%BC): 74] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 74] [Physical Therapy (%BC): 74] [Respiratory Services/Therapy  (%BC): 74] [Speech Therapy (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 78] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"1 through 10","median_amount":2250.89,"10th_percentile":2250.89,"90th_percentile":2250.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 39] [OP Surgery  (%BC): 39] [Observation (%BC): 39] [Emergency Department (%BC): 39] [Occupational Therapy (%BC): 39] [Physical Therapy (%BC): 39] [Respiratory Services/Therapy  (%BC): 39] [Speech Therapy (%BC): 39] [All Other OP (%BC): 39]","count":"1 through 10","median_amount":724.77,"10th_percentile":724.77,"90th_percentile":724.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"1 through 10","median_amount":10534.69,"10th_percentile":10534.69,"90th_percentile":10534.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":2640.24,"10th_percentile":2640.24,"90th_percentile":2640.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Mycare Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 75] [OP Surgery  (%BC): 75] [Observation (%BC): 75] [Emergency Department (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [All Other OP (%BC): 75]","count":"1 through 10","median_amount":3363.12,"10th_percentile":3363.12,"90th_percentile":3363.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72] [OP Surgery  (%BC): 72] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 72] [Physical Therapy (%BC): 72] [Respiratory Services/Therapy  (%BC): 72] [Speech Therapy (%BC): 72] [All Other OP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"1 through 10","median_amount":6489.9,"10th_percentile":6489.9,"90th_percentile":6764.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [ED Level 1--99281 ($): 27.09] [ED Level 2--99282 ($): 41.69] [ED Level 3--99283 ($): 73.69] [ED Level 4--99284 ($): 123.51] [ED Level 5--99285 ($): 223.93] [Clinic Visit ($): 59.34] [OP High Cost Drugs (%BC): 40] [Other Outpatient Implant (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"1 through 10","median_amount":8246.6,"10th_percentile":8246.6,"90th_percentile":8246.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 5 Gynecologic Procedures","code_information":[{"code":"5415","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 84] [OP Surgery  (%BC): 84] [Observation (%BC): 84] [Emergency Department (%BC): 84] [Occupational Therapy (%BC): 84] [Physical Therapy (%BC): 84] [Respiratory Services/Therapy  (%BC): 84] [Speech Therapy (%BC): 84] [All Other OP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41.82] [OP Surgery  (%BC): 41.82] [Observation (%BC): 41.82] [Emergency Department (%BC): 41.82] [Occupational Therapy (%BC): 41.82] [Physical Therapy (%BC): 41.82] [Respiratory Services/Therapy  (%BC): 41.82] [Speech Therapy (%BC): 41.82] [All Other OP (%BC): 41.82]","count":"1 through 10","median_amount":5211.14,"10th_percentile":5211.14,"90th_percentile":5211.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [All OP services (%BC): 77.4] [OP Surgery  (%BC): 77.4] [Observation (%BC): 77.4] [Emergency Department (%BC): 77.4] [Occupational Therapy (%BC): 77.4] [Physical Therapy (%BC): 77.4] [Respiratory Services/Therapy  (%BC): 77.4] [Speech Therapy (%BC): 77.4] [All Other OP (%BC): 77.4]","count":"1 through 10","median_amount":4903.42,"10th_percentile":2417.43,"90th_percentile":10943.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41] [OP Surgery  (%BC): 41] [Observation (%BC): 41] [Emergency Department (%BC): 41] [Occupational Therapy (%BC): 41] [Physical Therapy (%BC): 41] [Respiratory Services/Therapy  (%BC): 41] [Speech Therapy (%BC): 41] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 60.6] [OP Surgery  (%BC): 60.6] [Observation (%BC): 60.6] [Emergency Department (%BC): 60.6] [Occupational Therapy (%BC): 60.6] [Physical Therapy (%BC): 60.6] [Respiratory Services/Therapy  (%BC): 60.6] [Speech Therapy (%BC): 60.6] [All Other OP (%BC): 60.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Bluecard Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":3788.54,"10th_percentile":3788.54,"90th_percentile":3788.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [Emergency Department ($): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 79.2] [OP Surgery  (%BC): 79.2] [Observation (%BC): 79.2] [Emergency Department (%BC): 79.2] [Occupational Therapy (%BC): 79.2] [Physical Therapy (%BC): 79.2] [Respiratory Services/Therapy  (%BC): 79.2] [Speech Therapy (%BC): 79.2] [All Other OP (%BC): 79.2]","count":"1 through 10","median_amount":8425.98,"10th_percentile":8425.98,"90th_percentile":8425.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74] [Observation (%BC): 74] [Emergency Department (%BC): 74] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 74] [Physical Therapy (%BC): 74] [Respiratory Services/Therapy  (%BC): 74] [Speech Therapy (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 78] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 39] [OP Surgery  (%BC): 39] [Observation (%BC): 39] [Emergency Department (%BC): 39] [Occupational Therapy (%BC): 39] [Physical Therapy (%BC): 39] [Respiratory Services/Therapy  (%BC): 39] [Speech Therapy (%BC): 39] [All Other OP (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"1 through 10","median_amount":9738.34,"10th_percentile":9738.34,"90th_percentile":13773.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Mycare Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 75] [OP Surgery  (%BC): 75] [Observation (%BC): 75] [Emergency Department (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [All Other OP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72] [OP Surgery  (%BC): 72] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 72] [Physical Therapy (%BC): 72] [Respiratory Services/Therapy  (%BC): 72] [Speech Therapy (%BC): 72] [All Other OP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"1 through 10","median_amount":6882.19,"10th_percentile":6882.19,"90th_percentile":6882.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [ED Level 1--99281 ($): 27.09] [ED Level 2--99282 ($): 41.69] [ED Level 3--99283 ($): 73.69] [ED Level 4--99284 ($): 123.51] [ED Level 5--99285 ($): 223.93] [Clinic Visit ($): 59.34] [OP High Cost Drugs (%BC): 40] [Other Outpatient Implant (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 6 Gynecologic Procedures","code_information":[{"code":"5416","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 84] [OP Surgery  (%BC): 84] [Observation (%BC): 84] [Emergency Department (%BC): 84] [Occupational Therapy (%BC): 84] [Physical Therapy (%BC): 84] [Respiratory Services/Therapy  (%BC): 84] [Speech Therapy (%BC): 84] [All Other OP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41.82] [OP Surgery  (%BC): 41.82] [Observation (%BC): 41.82] [Emergency Department (%BC): 41.82] [Occupational Therapy (%BC): 41.82] [Physical Therapy (%BC): 41.82] [Respiratory Services/Therapy  (%BC): 41.82] [Speech Therapy (%BC): 41.82] [All Other OP (%BC): 41.82]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [All OP services (%BC): 77.4] [OP Surgery  (%BC): 77.4] [Observation (%BC): 77.4] [Emergency Department (%BC): 77.4] [Occupational Therapy (%BC): 77.4] [Physical Therapy (%BC): 77.4] [Respiratory Services/Therapy  (%BC): 77.4] [Speech Therapy (%BC): 77.4] [All Other OP (%BC): 77.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41] [OP Surgery  (%BC): 41] [Observation (%BC): 41] [Emergency Department (%BC): 41] [Occupational Therapy (%BC): 41] [Physical Therapy (%BC): 41] [Respiratory Services/Therapy  (%BC): 41] [Speech Therapy (%BC): 41] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 60.6] [OP Surgery  (%BC): 60.6] [Observation (%BC): 60.6] [Emergency Department (%BC): 60.6] [Occupational Therapy (%BC): 60.6] [Physical Therapy (%BC): 60.6] [Respiratory Services/Therapy  (%BC): 60.6] [Speech Therapy (%BC): 60.6] [All Other OP (%BC): 60.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Bluecard Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [Emergency Department ($): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 79.2] [OP Surgery  (%BC): 79.2] [Observation (%BC): 79.2] [Emergency Department (%BC): 79.2] [Occupational Therapy (%BC): 79.2] [Physical Therapy (%BC): 79.2] [Respiratory Services/Therapy  (%BC): 79.2] [Speech Therapy (%BC): 79.2] [All Other OP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74] [Observation (%BC): 74] [Emergency Department (%BC): 74] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 74] [Physical Therapy (%BC): 74] [Respiratory Services/Therapy  (%BC): 74] [Speech Therapy (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 78] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"1 through 10","median_amount":6362.73,"10th_percentile":6362.73,"90th_percentile":6362.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 39] [OP Surgery  (%BC): 39] [Observation (%BC): 39] [Emergency Department (%BC): 39] [Occupational Therapy (%BC): 39] [Physical Therapy (%BC): 39] [Respiratory Services/Therapy  (%BC): 39] [Speech Therapy (%BC): 39] [All Other OP (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"1 through 10","median_amount":18502.55,"10th_percentile":18502.55,"90th_percentile":18502.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Mycare Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 75] [OP Surgery  (%BC): 75] [Observation (%BC): 75] [Emergency Department (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [All Other OP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72] [OP Surgery  (%BC): 72] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 72] [Physical Therapy (%BC): 72] [Respiratory Services/Therapy  (%BC): 72] [Speech Therapy (%BC): 72] [All Other OP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [ED Level 1--99281 ($): 27.09] [ED Level 2--99282 ($): 41.69] [ED Level 3--99283 ($): 73.69] [ED Level 4--99284 ($): 123.51] [ED Level 5--99285 ($): 223.93] [Clinic Visit ($): 59.34] [OP High Cost Drugs (%BC): 40] [Other Outpatient Implant (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Nerve Procedures","code_information":[{"code":"5431","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 84] [OP Surgery  (%BC): 84] [Observation (%BC): 84] [Emergency Department (%BC): 84] [Occupational Therapy (%BC): 84] [Physical Therapy (%BC): 84] [Respiratory Services/Therapy  (%BC): 84] [Speech Therapy (%BC): 84] [All Other OP (%BC): 84]","count":"1 through 10","median_amount":3526.45,"10th_percentile":3526.45,"90th_percentile":3526.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41.82] [OP Surgery  (%BC): 41.82] [Observation (%BC): 41.82] [Emergency Department (%BC): 41.82] [Occupational Therapy (%BC): 41.82] [Physical Therapy (%BC): 41.82] [Respiratory Services/Therapy  (%BC): 41.82] [Speech Therapy (%BC): 41.82] [All Other OP (%BC): 41.82]","count":"1 through 10","median_amount":2491.16,"10th_percentile":2290.94,"90th_percentile":3353.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [All OP services (%BC): 77.4] [OP Surgery  (%BC): 77.4] [Observation (%BC): 77.4] [Emergency Department (%BC): 77.4] [Occupational Therapy (%BC): 77.4] [Physical Therapy (%BC): 77.4] [Respiratory Services/Therapy  (%BC): 77.4] [Speech Therapy (%BC): 77.4] [All Other OP (%BC): 77.4]","count":"24","median_amount":4744.04,"10th_percentile":2666.82,"90th_percentile":6753.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"1 through 10","median_amount":1981.81,"10th_percentile":1981.81,"90th_percentile":1981.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41] [OP Surgery  (%BC): 41] [Observation (%BC): 41] [Emergency Department (%BC): 41] [Occupational Therapy (%BC): 41] [Physical Therapy (%BC): 41] [Respiratory Services/Therapy  (%BC): 41] [Speech Therapy (%BC): 41] [All Other OP (%BC): 41]","count":"1 through 10","median_amount":2455.06,"10th_percentile":2001.63,"90th_percentile":3118.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 60.6] [OP Surgery  (%BC): 60.6] [Observation (%BC): 60.6] [Emergency Department (%BC): 60.6] [Occupational Therapy (%BC): 60.6] [Physical Therapy (%BC): 60.6] [Respiratory Services/Therapy  (%BC): 60.6] [Speech Therapy (%BC): 60.6] [All Other OP (%BC): 60.6]","count":"1 through 10","median_amount":3736.62,"10th_percentile":3736.62,"90th_percentile":3736.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Bluecard Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":1771.07,"10th_percentile":1771.07,"90th_percentile":1771.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [Emergency Department ($): 40]","count":"1 through 10","median_amount":1696.85,"10th_percentile":1696.85,"90th_percentile":1696.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 79.2] [OP Surgery  (%BC): 79.2] [Observation (%BC): 79.2] [Emergency Department (%BC): 79.2] [Occupational Therapy (%BC): 79.2] [Physical Therapy (%BC): 79.2] [Respiratory Services/Therapy  (%BC): 79.2] [Speech Therapy (%BC): 79.2] [All Other OP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74] [Observation (%BC): 74] [Emergency Department (%BC): 74] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 74] [Physical Therapy (%BC): 74] [Respiratory Services/Therapy  (%BC): 74] [Speech Therapy (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 78] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"1 through 10","median_amount":1781.69,"10th_percentile":1781.69,"90th_percentile":1781.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 39] [OP Surgery  (%BC): 39] [Observation (%BC): 39] [Emergency Department (%BC): 39] [Occupational Therapy (%BC): 39] [Physical Therapy (%BC): 39] [Respiratory Services/Therapy  (%BC): 39] [Speech Therapy (%BC): 39] [All Other OP (%BC): 39]","count":"1 through 10","median_amount":2208.31,"10th_percentile":2208.31,"90th_percentile":2208.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"11","median_amount":4279.6,"10th_percentile":3867.86,"90th_percentile":4752.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Mycare Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 75] [OP Surgery  (%BC): 75] [Observation (%BC): 75] [Emergency Department (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [All Other OP (%BC): 75]","count":"1 through 10","median_amount":2816.25,"10th_percentile":2816.25,"90th_percentile":3796.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72] [OP Surgery  (%BC): 72] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 72] [Physical Therapy (%BC): 72] [Respiratory Services/Therapy  (%BC): 72] [Speech Therapy (%BC): 72] [All Other OP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"1 through 10","median_amount":4095.19,"10th_percentile":3718.99,"90th_percentile":5238.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"1 through 10","median_amount":297.47,"10th_percentile":297.47,"90th_percentile":297.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [ED Level 1--99281 ($): 27.09] [ED Level 2--99282 ($): 41.69] [ED Level 3--99283 ($): 73.69] [ED Level 4--99284 ($): 123.51] [ED Level 5--99285 ($): 223.93] [Clinic Visit ($): 59.34] [OP High Cost Drugs (%BC): 40] [Other Outpatient Implant (%BC): 40]","count":"1 through 10","median_amount":1696.85,"10th_percentile":1696.85,"90th_percentile":1696.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"1 through 10","median_amount":3793.87,"10th_percentile":3793.87,"90th_percentile":6787.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Nerve Injections","code_information":[{"code":"5441","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 84] [OP Surgery  (%BC): 84] [Observation (%BC): 84] [Emergency Department (%BC): 84] [Occupational Therapy (%BC): 84] [Physical Therapy (%BC): 84] [Respiratory Services/Therapy  (%BC): 84] [Speech Therapy (%BC): 84] [All Other OP (%BC): 84]","count":"1 through 10","median_amount":1132.08,"10th_percentile":1132.08,"90th_percentile":1162.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":505.5,"10th_percentile":505.5,"90th_percentile":749.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41.82] [OP Surgery  (%BC): 41.82] [Observation (%BC): 41.82] [Emergency Department (%BC): 41.82] [Occupational Therapy (%BC): 41.82] [Physical Therapy (%BC): 41.82] [Respiratory Services/Therapy  (%BC): 41.82] [Speech Therapy (%BC): 41.82] [All Other OP (%BC): 41.82]","count":"58","median_amount":245.71,"10th_percentile":14.99,"90th_percentile":544.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [All OP services (%BC): 77.4] [OP Surgery  (%BC): 77.4] [Observation (%BC): 77.4] [Emergency Department (%BC): 77.4] [Occupational Therapy (%BC): 77.4] [Physical Therapy (%BC): 77.4] [Respiratory Services/Therapy  (%BC): 77.4] [Speech Therapy (%BC): 77.4] [All Other OP (%BC): 77.4]","count":"22","median_amount":1055.27,"10th_percentile":849.05,"90th_percentile":1750.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"1 through 10","median_amount":1251.08,"10th_percentile":1251.08,"90th_percentile":1251.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41] [OP Surgery  (%BC): 41] [Observation (%BC): 41] [Emergency Department (%BC): 41] [Occupational Therapy (%BC): 41] [Physical Therapy (%BC): 41] [Respiratory Services/Therapy  (%BC): 41] [Speech Therapy (%BC): 41] [All Other OP (%BC): 41]","count":"40","median_amount":115.76,"10th_percentile":13.94,"90th_percentile":498.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 60.6] [OP Surgery  (%BC): 60.6] [Observation (%BC): 60.6] [Emergency Department (%BC): 60.6] [Occupational Therapy (%BC): 60.6] [Physical Therapy (%BC): 60.6] [Respiratory Services/Therapy  (%BC): 60.6] [Speech Therapy (%BC): 60.6] [All Other OP (%BC): 60.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Bluecard Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":481.59,"10th_percentile":481.59,"90th_percentile":948.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [Emergency Department ($): 40]","count":"15","median_amount":64.2,"10th_percentile":37.09,"90th_percentile":1280.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":408.04,"10th_percentile":400.8,"90th_percentile":657.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 79.2] [OP Surgery  (%BC): 79.2] [Observation (%BC): 79.2] [Emergency Department (%BC): 79.2] [Occupational Therapy (%BC): 79.2] [Physical Therapy (%BC): 79.2] [Respiratory Services/Therapy  (%BC): 79.2] [Speech Therapy (%BC): 79.2] [All Other OP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74] [Observation (%BC): 74] [Emergency Department (%BC): 74] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 74] [Physical Therapy (%BC): 74] [Respiratory Services/Therapy  (%BC): 74] [Speech Therapy (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 78] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"1 through 10","median_amount":363.64,"10th_percentile":363.64,"90th_percentile":604.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 39] [OP Surgery  (%BC): 39] [Observation (%BC): 39] [Emergency Department (%BC): 39] [Occupational Therapy (%BC): 39] [Physical Therapy (%BC): 39] [Respiratory Services/Therapy  (%BC): 39] [Speech Therapy (%BC): 39] [All Other OP (%BC): 39]","count":"23","median_amount":140.54,"10th_percentile":14.41,"90th_percentile":518.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"1 through 10","median_amount":790.94,"10th_percentile":29.73,"90th_percentile":1003.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Mycare Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 75] [OP Surgery  (%BC): 75] [Observation (%BC): 75] [Emergency Department (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [All Other OP (%BC): 75]","count":"18","median_amount":492.15,"10th_percentile":20.64,"90th_percentile":1324.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72] [OP Surgery  (%BC): 72] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 72] [Physical Therapy (%BC): 72] [Respiratory Services/Therapy  (%BC): 72] [Speech Therapy (%BC): 72] [All Other OP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"1 through 10","median_amount":1174.27,"10th_percentile":1174.27,"90th_percentile":2314.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [ED Level 1--99281 ($): 27.09] [ED Level 2--99282 ($): 41.69] [ED Level 3--99283 ($): 73.69] [ED Level 4--99284 ($): 123.51] [ED Level 5--99285 ($): 223.93] [Clinic Visit ($): 59.34] [OP High Cost Drugs (%BC): 40] [Other Outpatient Implant (%BC): 40]","count":"1 through 10","median_amount":60.66,"10th_percentile":60.66,"90th_percentile":272.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"24","median_amount":501.27,"10th_percentile":23.08,"90th_percentile":1192.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":228.51,"10th_percentile":228.51,"90th_percentile":228.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Nerve Injections","code_information":[{"code":"5442","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 84] [OP Surgery  (%BC): 84] [Observation (%BC): 84] [Emergency Department (%BC): 84] [Occupational Therapy (%BC): 84] [Physical Therapy (%BC): 84] [Respiratory Services/Therapy  (%BC): 84] [Speech Therapy (%BC): 84] [All Other OP (%BC): 84]","count":"1 through 10","median_amount":1792.74,"10th_percentile":1792.74,"90th_percentile":1792.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41.82] [OP Surgery  (%BC): 41.82] [Observation (%BC): 41.82] [Emergency Department (%BC): 41.82] [Occupational Therapy (%BC): 41.82] [Physical Therapy (%BC): 41.82] [Respiratory Services/Therapy  (%BC): 41.82] [Speech Therapy (%BC): 41.82] [All Other OP (%BC): 41.82]","count":"1 through 10","median_amount":774.07,"10th_percentile":424.81,"90th_percentile":3197.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [All OP services (%BC): 77.4] [OP Surgery  (%BC): 77.4] [Observation (%BC): 77.4] [Emergency Department (%BC): 77.4] [Occupational Therapy (%BC): 77.4] [Physical Therapy (%BC): 77.4] [Respiratory Services/Therapy  (%BC): 77.4] [Speech Therapy (%BC): 77.4] [All Other OP (%BC): 77.4]","count":"1 through 10","median_amount":1716.7,"10th_percentile":1624.55,"90th_percentile":5475.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41] [OP Surgery  (%BC): 41] [Observation (%BC): 41] [Emergency Department (%BC): 41] [Occupational Therapy (%BC): 41] [Physical Therapy (%BC): 41] [Respiratory Services/Therapy  (%BC): 41] [Speech Therapy (%BC): 41] [All Other OP (%BC): 41]","count":"1 through 10","median_amount":436.73,"10th_percentile":436.73,"90th_percentile":436.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 60.6] [OP Surgery  (%BC): 60.6] [Observation (%BC): 60.6] [Emergency Department (%BC): 60.6] [Occupational Therapy (%BC): 60.6] [Physical Therapy (%BC): 60.6] [Respiratory Services/Therapy  (%BC): 60.6] [Speech Therapy (%BC): 60.6] [All Other OP (%BC): 60.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Bluecard Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":416.47,"10th_percentile":416.47,"90th_percentile":416.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [Emergency Department ($): 40]","count":"1 through 10","median_amount":850.79,"10th_percentile":850.79,"90th_percentile":850.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":492.7,"10th_percentile":492.7,"90th_percentile":492.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 79.2] [OP Surgery  (%BC): 79.2] [Observation (%BC): 79.2] [Emergency Department (%BC): 79.2] [Occupational Therapy (%BC): 79.2] [Physical Therapy (%BC): 79.2] [Respiratory Services/Therapy  (%BC): 79.2] [Speech Therapy (%BC): 79.2] [All Other OP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74] [Observation (%BC): 74] [Emergency Department (%BC): 74] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 74] [Physical Therapy (%BC): 74] [Respiratory Services/Therapy  (%BC): 74] [Speech Therapy (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 78] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 39] [OP Surgery  (%BC): 39] [Observation (%BC): 39] [Emergency Department (%BC): 39] [Occupational Therapy (%BC): 39] [Physical Therapy (%BC): 39] [Respiratory Services/Therapy  (%BC): 39] [Speech Therapy (%BC): 39] [All Other OP (%BC): 39]","count":"1 through 10","median_amount":847.09,"10th_percentile":847.09,"90th_percentile":847.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"1 through 10","median_amount":1940.19,"10th_percentile":1940.19,"90th_percentile":2675.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Mycare Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 75] [OP Surgery  (%BC): 75] [Observation (%BC): 75] [Emergency Department (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [All Other OP (%BC): 75]","count":"1 through 10","median_amount":438.45,"10th_percentile":438.45,"90th_percentile":438.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72] [OP Surgery  (%BC): 72] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 72] [Physical Therapy (%BC): 72] [Respiratory Services/Therapy  (%BC): 72] [Speech Therapy (%BC): 72] [All Other OP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"1 through 10","median_amount":407.55,"10th_percentile":407.55,"90th_percentile":407.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [ED Level 1--99281 ($): 27.09] [ED Level 2--99282 ($): 41.69] [ED Level 3--99283 ($): 73.69] [ED Level 4--99284 ($): 123.51] [ED Level 5--99285 ($): 223.93] [Clinic Visit ($): 59.34] [OP High Cost Drugs (%BC): 40] [Other Outpatient Implant (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":613.25,"10th_percentile":613.25,"90th_percentile":613.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Nerve Injections","code_information":[{"code":"5443","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 84] [OP Surgery  (%BC): 84] [Observation (%BC): 84] [Emergency Department (%BC): 84] [Occupational Therapy (%BC): 84] [Physical Therapy (%BC): 84] [Respiratory Services/Therapy  (%BC): 84] [Speech Therapy (%BC): 84] [All Other OP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41.82] [OP Surgery  (%BC): 41.82] [Observation (%BC): 41.82] [Emergency Department (%BC): 41.82] [Occupational Therapy (%BC): 41.82] [Physical Therapy (%BC): 41.82] [Respiratory Services/Therapy  (%BC): 41.82] [Speech Therapy (%BC): 41.82] [All Other OP (%BC): 41.82]","count":"1 through 10","median_amount":1083.81,"10th_percentile":719.79,"90th_percentile":1087.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [All OP services (%BC): 77.4] [OP Surgery  (%BC): 77.4] [Observation (%BC): 77.4] [Emergency Department (%BC): 77.4] [Occupational Therapy (%BC): 77.4] [Physical Therapy (%BC): 77.4] [Respiratory Services/Therapy  (%BC): 77.4] [Speech Therapy (%BC): 77.4] [All Other OP (%BC): 77.4]","count":"1 through 10","median_amount":1480.11,"10th_percentile":1480.11,"90th_percentile":2272.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41] [OP Surgery  (%BC): 41] [Observation (%BC): 41] [Emergency Department (%BC): 41] [Occupational Therapy (%BC): 41] [Physical Therapy (%BC): 41] [Respiratory Services/Therapy  (%BC): 41] [Speech Therapy (%BC): 41] [All Other OP (%BC): 41]","count":"1 through 10","median_amount":924.21,"10th_percentile":924.21,"90th_percentile":924.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 60.6] [OP Surgery  (%BC): 60.6] [Observation (%BC): 60.6] [Emergency Department (%BC): 60.6] [Occupational Therapy (%BC): 60.6] [Physical Therapy (%BC): 60.6] [Respiratory Services/Therapy  (%BC): 60.6] [Speech Therapy (%BC): 60.6] [All Other OP (%BC): 60.6]","count":"1 through 10","median_amount":1734.93,"10th_percentile":1734.93,"90th_percentile":1734.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Bluecard Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [Emergency Department ($): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 79.2] [OP Surgery  (%BC): 79.2] [Observation (%BC): 79.2] [Emergency Department (%BC): 79.2] [Occupational Therapy (%BC): 79.2] [Physical Therapy (%BC): 79.2] [Respiratory Services/Therapy  (%BC): 79.2] [Speech Therapy (%BC): 79.2] [All Other OP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74] [Observation (%BC): 74] [Emergency Department (%BC): 74] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 74] [Physical Therapy (%BC): 74] [Respiratory Services/Therapy  (%BC): 74] [Speech Therapy (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 78] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 39] [OP Surgery  (%BC): 39] [Observation (%BC): 39] [Emergency Department (%BC): 39] [Occupational Therapy (%BC): 39] [Physical Therapy (%BC): 39] [Respiratory Services/Therapy  (%BC): 39] [Speech Therapy (%BC): 39] [All Other OP (%BC): 39]","count":"1 through 10","median_amount":919.88,"10th_percentile":919.88,"90th_percentile":919.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"1 through 10","median_amount":2117.09,"10th_percentile":2117.09,"90th_percentile":2117.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Mycare Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 75] [OP Surgery  (%BC): 75] [Observation (%BC): 75] [Emergency Department (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [All Other OP (%BC): 75]","count":"1 through 10","median_amount":993.24,"10th_percentile":993.24,"90th_percentile":993.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72] [OP Surgery  (%BC): 72] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 72] [Physical Therapy (%BC): 72] [Respiratory Services/Therapy  (%BC): 72] [Speech Therapy (%BC): 72] [All Other OP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [ED Level 1--99281 ($): 27.09] [ED Level 2--99282 ($): 41.69] [ED Level 3--99283 ($): 73.69] [ED Level 4--99284 ($): 123.51] [ED Level 5--99285 ($): 223.93] [Clinic Visit ($): 59.34] [OP High Cost Drugs (%BC): 40] [Other Outpatient Implant (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"1 through 10","median_amount":1084.34,"10th_percentile":1084.34,"90th_percentile":1084.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Neurostimulator and Related Procedures","code_information":[{"code":"5464","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 84] [OP Surgery  (%BC): 84] [Observation (%BC): 84] [Emergency Department (%BC): 84] [Occupational Therapy (%BC): 84] [Physical Therapy (%BC): 84] [Respiratory Services/Therapy  (%BC): 84] [Speech Therapy (%BC): 84] [All Other OP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41.82] [OP Surgery  (%BC): 41.82] [Observation (%BC): 41.82] [Emergency Department (%BC): 41.82] [Occupational Therapy (%BC): 41.82] [Physical Therapy (%BC): 41.82] [Respiratory Services/Therapy  (%BC): 41.82] [Speech Therapy (%BC): 41.82] [All Other OP (%BC): 41.82]","count":"1 through 10","median_amount":10634.96,"10th_percentile":10634.96,"90th_percentile":10634.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [All OP services (%BC): 77.4] [OP Surgery  (%BC): 77.4] [Observation (%BC): 77.4] [Emergency Department (%BC): 77.4] [Occupational Therapy (%BC): 77.4] [Physical Therapy (%BC): 77.4] [Respiratory Services/Therapy  (%BC): 77.4] [Speech Therapy (%BC): 77.4] [All Other OP (%BC): 77.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41] [OP Surgery  (%BC): 41] [Observation (%BC): 41] [Emergency Department (%BC): 41] [Occupational Therapy (%BC): 41] [Physical Therapy (%BC): 41] [Respiratory Services/Therapy  (%BC): 41] [Speech Therapy (%BC): 41] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 60.6] [OP Surgery  (%BC): 60.6] [Observation (%BC): 60.6] [Emergency Department (%BC): 60.6] [Occupational Therapy (%BC): 60.6] [Physical Therapy (%BC): 60.6] [Respiratory Services/Therapy  (%BC): 60.6] [Speech Therapy (%BC): 60.6] [All Other OP (%BC): 60.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Bluecard Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [Emergency Department ($): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 79.2] [OP Surgery  (%BC): 79.2] [Observation (%BC): 79.2] [Emergency Department (%BC): 79.2] [Occupational Therapy (%BC): 79.2] [Physical Therapy (%BC): 79.2] [Respiratory Services/Therapy  (%BC): 79.2] [Speech Therapy (%BC): 79.2] [All Other OP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74] [Observation (%BC): 74] [Emergency Department (%BC): 74] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 74] [Physical Therapy (%BC): 74] [Respiratory Services/Therapy  (%BC): 74] [Speech Therapy (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 78] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 39] [OP Surgery  (%BC): 39] [Observation (%BC): 39] [Emergency Department (%BC): 39] [Occupational Therapy (%BC): 39] [Physical Therapy (%BC): 39] [Respiratory Services/Therapy  (%BC): 39] [Speech Therapy (%BC): 39] [All Other OP (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Mycare Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 75] [OP Surgery  (%BC): 75] [Observation (%BC): 75] [Emergency Department (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [All Other OP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72] [OP Surgery  (%BC): 72] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 72] [Physical Therapy (%BC): 72] [Respiratory Services/Therapy  (%BC): 72] [Speech Therapy (%BC): 72] [All Other OP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [ED Level 1--99281 ($): 27.09] [ED Level 2--99282 ($): 41.69] [ED Level 3--99283 ($): 73.69] [ED Level 4--99284 ($): 123.51] [ED Level 5--99285 ($): 223.93] [Clinic Visit ($): 59.34] [OP High Cost Drugs (%BC): 40] [Other Outpatient Implant (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Imaging without Contrast","code_information":[{"code":"5521","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 84] [OP Surgery  (%BC): 84] [Observation (%BC): 84] [Emergency Department (%BC): 84] [Occupational Therapy (%BC): 84] [Physical Therapy (%BC): 84] [Respiratory Services/Therapy  (%BC): 84] [Speech Therapy (%BC): 84] [All Other OP (%BC): 84]","count":"95","median_amount":225.23,"10th_percentile":204.67,"90th_percentile":535.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"19","median_amount":100.16,"10th_percentile":89.56,"90th_percentile":253.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41.82] [OP Surgery  (%BC): 41.82] [Observation (%BC): 41.82] [Emergency Department (%BC): 41.82] [Occupational Therapy (%BC): 41.82] [Physical Therapy (%BC): 41.82] [Respiratory Services/Therapy  (%BC): 41.82] [Speech Therapy (%BC): 41.82] [All Other OP (%BC): 41.82]","count":"449","median_amount":118.13,"10th_percentile":93.24,"90th_percentile":309.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":94.99,"10th_percentile":94.99,"90th_percentile":94.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [All OP services (%BC): 77.4] [OP Surgery  (%BC): 77.4] [Observation (%BC): 77.4] [Emergency Department (%BC): 77.4] [Occupational Therapy (%BC): 77.4] [Physical Therapy (%BC): 77.4] [Respiratory Services/Therapy  (%BC): 77.4] [Speech Therapy (%BC): 77.4] [All Other OP (%BC): 77.4]","count":"1055","median_amount":210.27,"10th_percentile":88.39,"90th_percentile":500.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"67","median_amount":98.56,"10th_percentile":90.91,"90th_percentile":346.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41] [OP Surgery  (%BC): 41] [Observation (%BC): 41] [Emergency Department (%BC): 41] [Occupational Therapy (%BC): 41] [Physical Therapy (%BC): 41] [Respiratory Services/Therapy  (%BC): 41] [Speech Therapy (%BC): 41] [All Other OP (%BC): 41]","count":"264","median_amount":112.37,"10th_percentile":91.02,"90th_percentile":283.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 60.6] [OP Surgery  (%BC): 60.6] [Observation (%BC): 60.6] [Emergency Department (%BC): 60.6] [Occupational Therapy (%BC): 60.6] [Physical Therapy (%BC): 60.6] [Respiratory Services/Therapy  (%BC): 60.6] [Speech Therapy (%BC): 60.6] [All Other OP (%BC): 60.6]","count":"37","median_amount":200.11,"10th_percentile":159.83,"90th_percentile":546.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Bluecard Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"40","median_amount":112.42,"10th_percentile":93.8,"90th_percentile":327.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [Emergency Department ($): 40]","count":"303","median_amount":88.39,"10th_percentile":85.43,"90th_percentile":168.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"59","median_amount":88.39,"10th_percentile":85.43,"90th_percentile":234.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 79.2] [OP Surgery  (%BC): 79.2] [Observation (%BC): 79.2] [Emergency Department (%BC): 79.2] [Occupational Therapy (%BC): 79.2] [Physical Therapy (%BC): 79.2] [Respiratory Services/Therapy  (%BC): 79.2] [Speech Therapy (%BC): 79.2] [All Other OP (%BC): 79.2]","count":"29","median_amount":283.14,"10th_percentile":195.67,"90th_percentile":801.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":206.0,"10th_percentile":206.0,"90th_percentile":206.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74] [Observation (%BC): 74] [Emergency Department (%BC): 74] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 74] [Physical Therapy (%BC): 74] [Respiratory Services/Therapy  (%BC): 74] [Speech Therapy (%BC): 74] [All Other OP (%BC): 74]","count":"26","median_amount":199.16,"10th_percentile":182.82,"90th_percentile":338.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 78] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"79","median_amount":92.81,"10th_percentile":89.7,"90th_percentile":272.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 39] [OP Surgery  (%BC): 39] [Observation (%BC): 39] [Emergency Department (%BC): 39] [Occupational Therapy (%BC): 39] [Physical Therapy (%BC): 39] [Respiratory Services/Therapy  (%BC): 39] [Speech Therapy (%BC): 39] [All Other OP (%BC): 39]","count":"174","median_amount":125.64,"10th_percentile":89.56,"90th_percentile":292.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"410","median_amount":204.76,"10th_percentile":167.29,"90th_percentile":482.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"25","median_amount":91.04,"10th_percentile":87.99,"90th_percentile":136.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Mycare Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"1 through 10","median_amount":460.2,"10th_percentile":460.2,"90th_percentile":531.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 75] [OP Surgery  (%BC): 75] [Observation (%BC): 75] [Emergency Department (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [All Other OP (%BC): 75]","count":"317","median_amount":161.23,"10th_percentile":89.98,"90th_percentile":404.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72] [OP Surgery  (%BC): 72] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 72] [Physical Therapy (%BC): 72] [Respiratory Services/Therapy  (%BC): 72] [Speech Therapy (%BC): 72] [All Other OP (%BC): 72]","count":"1 through 10","median_amount":487.09,"10th_percentile":487.09,"90th_percentile":600.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"1 through 10","median_amount":228.76,"10th_percentile":228.76,"90th_percentile":228.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"99","median_amount":262.21,"10th_percentile":216.39,"90th_percentile":689.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"39","median_amount":223.19,"10th_percentile":191.71,"90th_percentile":527.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [ED Level 1--99281 ($): 27.09] [ED Level 2--99282 ($): 41.69] [ED Level 3--99283 ($): 73.69] [ED Level 4--99284 ($): 123.51] [ED Level 5--99285 ($): 223.93] [Clinic Visit ($): 59.34] [OP High Cost Drugs (%BC): 40] [Other Outpatient Implant (%BC): 40]","count":"29","median_amount":88.39,"10th_percentile":85.43,"90th_percentile":143.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"186","median_amount":216.48,"10th_percentile":100.86,"90th_percentile":580.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"1 through 10","median_amount":320.19,"10th_percentile":320.19,"90th_percentile":350.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"16","median_amount":145.5,"10th_percentile":94.99,"90th_percentile":347.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Imaging without Contrast","code_information":[{"code":"5522","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 84] [OP Surgery  (%BC): 84] [Observation (%BC): 84] [Emergency Department (%BC): 84] [Occupational Therapy (%BC): 84] [Physical Therapy (%BC): 84] [Respiratory Services/Therapy  (%BC): 84] [Speech Therapy (%BC): 84] [All Other OP (%BC): 84]","count":"52","median_amount":614.45,"10th_percentile":421.6,"90th_percentile":1462.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"31","median_amount":360.64,"10th_percentile":254.72,"90th_percentile":699.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41.82] [OP Surgery  (%BC): 41.82] [Observation (%BC): 41.82] [Emergency Department (%BC): 41.82] [Occupational Therapy (%BC): 41.82] [Physical Therapy (%BC): 41.82] [Respiratory Services/Therapy  (%BC): 41.82] [Speech Therapy (%BC): 41.82] [All Other OP (%BC): 41.82]","count":"328","median_amount":340.95,"10th_percentile":187.88,"90th_percentile":725.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":198.66,"10th_percentile":179.19,"90th_percentile":326.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [All OP services (%BC): 77.4] [OP Surgery  (%BC): 77.4] [Observation (%BC): 77.4] [Emergency Department (%BC): 77.4] [Occupational Therapy (%BC): 77.4] [Physical Therapy (%BC): 77.4] [Respiratory Services/Therapy  (%BC): 77.4] [Speech Therapy (%BC): 77.4] [All Other OP (%BC): 77.4]","count":"721","median_amount":535.87,"10th_percentile":152.08,"90th_percentile":1261.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"42","median_amount":328.84,"10th_percentile":189.78,"90th_percentile":696.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41] [OP Surgery  (%BC): 41] [Observation (%BC): 41] [Emergency Department (%BC): 41] [Occupational Therapy (%BC): 41] [Physical Therapy (%BC): 41] [Respiratory Services/Therapy  (%BC): 41] [Speech Therapy (%BC): 41] [All Other OP (%BC): 41]","count":"225","median_amount":325.29,"10th_percentile":155.44,"90th_percentile":696.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 60.6] [OP Surgery  (%BC): 60.6] [Observation (%BC): 60.6] [Emergency Department (%BC): 60.6] [Occupational Therapy (%BC): 60.6] [Physical Therapy (%BC): 60.6] [Respiratory Services/Therapy  (%BC): 60.6] [Speech Therapy (%BC): 60.6] [All Other OP (%BC): 60.6]","count":"27","median_amount":471.04,"10th_percentile":167.3,"90th_percentile":1187.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Bluecard Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"35","median_amount":333.09,"10th_percentile":193.65,"90th_percentile":381.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [Emergency Department ($): 40]","count":"180","median_amount":181.94,"10th_percentile":88.39,"90th_percentile":347.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"33","median_amount":181.94,"10th_percentile":124.99,"90th_percentile":285.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 79.2] [OP Surgery  (%BC): 79.2] [Observation (%BC): 79.2] [Emergency Department (%BC): 79.2] [Occupational Therapy (%BC): 79.2] [Physical Therapy (%BC): 79.2] [Respiratory Services/Therapy  (%BC): 79.2] [Speech Therapy (%BC): 79.2] [All Other OP (%BC): 79.2]","count":"16","median_amount":517.48,"10th_percentile":414.51,"90th_percentile":1257.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":792.44,"10th_percentile":792.44,"90th_percentile":1149.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 78] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"80","median_amount":184.65,"10th_percentile":92.81,"90th_percentile":300.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 39] [OP Surgery  (%BC): 39] [Observation (%BC): 39] [Emergency Department (%BC): 39] [Occupational Therapy (%BC): 39] [Physical Therapy (%BC): 39] [Respiratory Services/Therapy  (%BC): 39] [Speech Therapy (%BC): 39] [All Other OP (%BC): 39]","count":"132","median_amount":269.49,"10th_percentile":100.16,"90th_percentile":557.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"310","median_amount":480.24,"10th_percentile":195.47,"90th_percentile":1118.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"12","median_amount":156.64,"10th_percentile":116.94,"90th_percentile":237.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Mycare Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"1 through 10","median_amount":115.78,"10th_percentile":115.78,"90th_percentile":115.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 75] [OP Surgery  (%BC): 75] [Observation (%BC): 75] [Emergency Department (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [All Other OP (%BC): 75]","count":"262","median_amount":340.67,"10th_percentile":151.75,"90th_percentile":723.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72] [OP Surgery  (%BC): 72] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 72] [Physical Therapy (%BC): 72] [Respiratory Services/Therapy  (%BC): 72] [Speech Therapy (%BC): 72] [All Other OP (%BC): 72]","count":"1 through 10","median_amount":507.66,"10th_percentile":358.44,"90th_percentile":697.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"1 through 10","median_amount":1448.0,"10th_percentile":1448.0,"90th_percentile":1448.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"76","median_amount":656.44,"10th_percentile":377.88,"90th_percentile":1658.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"31","median_amount":566.25,"10th_percentile":269.57,"90th_percentile":1657.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [ED Level 1--99281 ($): 27.09] [ED Level 2--99282 ($): 41.69] [ED Level 3--99283 ($): 73.69] [ED Level 4--99284 ($): 123.51] [ED Level 5--99285 ($): 223.93] [Clinic Visit ($): 59.34] [OP High Cost Drugs (%BC): 40] [Other Outpatient Implant (%BC): 40]","count":"30","median_amount":152.08,"10th_percentile":88.39,"90th_percentile":385.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"131","median_amount":402.41,"10th_percentile":211.16,"90th_percentile":900.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"1 through 10","median_amount":658.1,"10th_percentile":242.4,"90th_percentile":1998.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"16","median_amount":267.57,"10th_percentile":196.29,"90th_percentile":744.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Imaging without Contrast","code_information":[{"code":"5523","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 84] [OP Surgery  (%BC): 84] [Observation (%BC): 84] [Emergency Department (%BC): 84] [Occupational Therapy (%BC): 84] [Physical Therapy (%BC): 84] [Respiratory Services/Therapy  (%BC): 84] [Speech Therapy (%BC): 84] [All Other OP (%BC): 84]","count":"26","median_amount":2190.27,"10th_percentile":1054.97,"90th_percentile":2625.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":783.36,"10th_percentile":692.84,"90th_percentile":1007.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41.82] [OP Surgery  (%BC): 41.82] [Observation (%BC): 41.82] [Emergency Department (%BC): 41.82] [Occupational Therapy (%BC): 41.82] [Physical Therapy (%BC): 41.82] [Respiratory Services/Therapy  (%BC): 41.82] [Speech Therapy (%BC): 41.82] [All Other OP (%BC): 41.82]","count":"116","median_amount":899.82,"10th_percentile":415.48,"90th_percentile":1100.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [All OP services (%BC): 77.4] [OP Surgery  (%BC): 77.4] [Observation (%BC): 77.4] [Emergency Department (%BC): 77.4] [Occupational Therapy (%BC): 77.4] [Physical Therapy (%BC): 77.4] [Respiratory Services/Therapy  (%BC): 77.4] [Speech Therapy (%BC): 77.4] [All Other OP (%BC): 77.4]","count":"253","median_amount":2103.4,"10th_percentile":397.65,"90th_percentile":2183.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"21","median_amount":1007.63,"10th_percentile":461.65,"90th_percentile":1601.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41] [OP Surgery  (%BC): 41] [Observation (%BC): 41] [Emergency Department (%BC): 41] [Occupational Therapy (%BC): 41] [Physical Therapy (%BC): 41] [Respiratory Services/Therapy  (%BC): 41] [Speech Therapy (%BC): 41] [All Other OP (%BC): 41]","count":"90","median_amount":907.7,"10th_percentile":380.61,"90th_percentile":1011.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 60.6] [OP Surgery  (%BC): 60.6] [Observation (%BC): 60.6] [Emergency Department (%BC): 60.6] [Occupational Therapy (%BC): 60.6] [Physical Therapy (%BC): 60.6] [Respiratory Services/Therapy  (%BC): 60.6] [Speech Therapy (%BC): 60.6] [All Other OP (%BC): 60.6]","count":"14","median_amount":1710.37,"10th_percentile":621.91,"90th_percentile":2318.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Bluecard Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"13","median_amount":956.51,"10th_percentile":386.44,"90th_percentile":1387.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [Emergency Department ($): 40]","count":"48","median_amount":397.65,"10th_percentile":384.35,"90th_percentile":612.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":397.65,"10th_percentile":233.89,"90th_percentile":402.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 79.2] [OP Surgery  (%BC): 79.2] [Observation (%BC): 79.2] [Emergency Department (%BC): 79.2] [Occupational Therapy (%BC): 79.2] [Physical Therapy (%BC): 79.2] [Respiratory Services/Therapy  (%BC): 79.2] [Speech Therapy (%BC): 79.2] [All Other OP (%BC): 79.2]","count":"1 through 10","median_amount":2084.97,"10th_percentile":1303.86,"90th_percentile":2191.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":1315.24,"10th_percentile":1315.24,"90th_percentile":1315.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74] [Observation (%BC): 74] [Emergency Department (%BC): 74] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 74] [Physical Therapy (%BC): 74] [Respiratory Services/Therapy  (%BC): 74] [Speech Therapy (%BC): 74] [All Other OP (%BC): 74]","count":"1 through 10","median_amount":2048.02,"10th_percentile":892.53,"90th_percentile":2048.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 78] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [All Other OP (%BC): 78]","count":"1 through 10","median_amount":2048.02,"10th_percentile":2048.02,"90th_percentile":2048.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"13","median_amount":417.53,"10th_percentile":245.58,"90th_percentile":643.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 39] [OP Surgery  (%BC): 39] [Observation (%BC): 39] [Emergency Department (%BC): 39] [Occupational Therapy (%BC): 39] [Physical Therapy (%BC): 39] [Respiratory Services/Therapy  (%BC): 39] [Speech Therapy (%BC): 39] [All Other OP (%BC): 39]","count":"44","median_amount":786.18,"10th_percentile":378.71,"90th_percentile":1064.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"118","median_amount":1934.92,"10th_percentile":846.81,"90th_percentile":2034.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Mycare Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 75] [OP Surgery  (%BC): 75] [Observation (%BC): 75] [Emergency Department (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [All Other OP (%BC): 75]","count":"74","median_amount":1000.21,"10th_percentile":400.19,"90th_percentile":2065.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72] [OP Surgery  (%BC): 72] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 72] [Physical Therapy (%BC): 72] [Respiratory Services/Therapy  (%BC): 72] [Speech Therapy (%BC): 72] [All Other OP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"40","median_amount":2271.88,"10th_percentile":1094.28,"90th_percentile":2589.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"21","median_amount":2279.57,"10th_percentile":904.4,"90th_percentile":2435.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [ED Level 1--99281 ($): 27.09] [ED Level 2--99282 ($): 41.69] [ED Level 3--99283 ($): 73.69] [ED Level 4--99284 ($): 123.51] [ED Level 5--99285 ($): 223.93] [Clinic Visit ($): 59.34] [OP High Cost Drugs (%BC): 40] [Other Outpatient Implant (%BC): 40]","count":"13","median_amount":384.35,"10th_percentile":233.89,"90th_percentile":612.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"65","median_amount":1079.36,"10th_percentile":663.34,"90th_percentile":2316.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"1 through 10","median_amount":492.84,"10th_percentile":492.84,"90th_percentile":674.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":781.48,"10th_percentile":379.71,"90th_percentile":1307.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 4 Imaging without Contrast","code_information":[{"code":"5524","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 84] [OP Surgery  (%BC): 84] [Observation (%BC): 84] [Emergency Department (%BC): 84] [Occupational Therapy (%BC): 84] [Physical Therapy (%BC): 84] [Respiratory Services/Therapy  (%BC): 84] [Speech Therapy (%BC): 84] [All Other OP (%BC): 84]","count":"1 through 10","median_amount":1665.67,"10th_percentile":1605.83,"90th_percentile":3103.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":702.7,"10th_percentile":702.7,"90th_percentile":804.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41.82] [OP Surgery  (%BC): 41.82] [Observation (%BC): 41.82] [Emergency Department (%BC): 41.82] [Occupational Therapy (%BC): 41.82] [Physical Therapy (%BC): 41.82] [Respiratory Services/Therapy  (%BC): 41.82] [Speech Therapy (%BC): 41.82] [All Other OP (%BC): 41.82]","count":"52","median_amount":767.79,"10th_percentile":728.42,"90th_percentile":1100.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [All OP services (%BC): 77.4] [OP Surgery  (%BC): 77.4] [Observation (%BC): 77.4] [Emergency Department (%BC): 77.4] [Occupational Therapy (%BC): 77.4] [Physical Therapy (%BC): 77.4] [Respiratory Services/Therapy  (%BC): 77.4] [Speech Therapy (%BC): 77.4] [All Other OP (%BC): 77.4]","count":"75","median_amount":1522.84,"10th_percentile":694.89,"90th_percentile":1856.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"1 through 10","median_amount":856.09,"10th_percentile":702.7,"90th_percentile":921.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41] [OP Surgery  (%BC): 41] [Observation (%BC): 41] [Emergency Department (%BC): 41] [Occupational Therapy (%BC): 41] [Physical Therapy (%BC): 41] [Respiratory Services/Therapy  (%BC): 41] [Speech Therapy (%BC): 41] [All Other OP (%BC): 41]","count":"37","median_amount":707.75,"10th_percentile":667.6,"90th_percentile":1053.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 60.6] [OP Surgery  (%BC): 60.6] [Observation (%BC): 60.6] [Emergency Department (%BC): 60.6] [Occupational Therapy (%BC): 60.6] [Physical Therapy (%BC): 60.6] [Respiratory Services/Therapy  (%BC): 60.6] [Speech Therapy (%BC): 60.6] [All Other OP (%BC): 60.6]","count":"1 through 10","median_amount":1192.8,"10th_percentile":1192.8,"90th_percentile":1192.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Bluecard Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":852.62,"10th_percentile":714.13,"90th_percentile":7081.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [Emergency Department ($): 40]","count":"1 through 10","median_amount":718.94,"10th_percentile":549.99,"90th_percentile":878.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":549.99,"10th_percentile":549.99,"90th_percentile":734.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 79.2] [OP Surgery  (%BC): 79.2] [Observation (%BC): 79.2] [Emergency Department (%BC): 79.2] [Occupational Therapy (%BC): 79.2] [Physical Therapy (%BC): 79.2] [Respiratory Services/Therapy  (%BC): 79.2] [Speech Therapy (%BC): 79.2] [All Other OP (%BC): 79.2]","count":"1 through 10","median_amount":4589.23,"10th_percentile":4589.23,"90th_percentile":4589.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74] [Observation (%BC): 74] [Emergency Department (%BC): 74] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 74] [Physical Therapy (%BC): 74] [Respiratory Services/Therapy  (%BC): 74] [Speech Therapy (%BC): 74] [All Other OP (%BC): 74]","count":"1 through 10","median_amount":780.36,"10th_percentile":780.36,"90th_percentile":780.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 78] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"1 through 10","median_amount":1128.82,"10th_percentile":1128.82,"90th_percentile":2254.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 39] [OP Surgery  (%BC): 39] [Observation (%BC): 39] [Emergency Department (%BC): 39] [Occupational Therapy (%BC): 39] [Physical Therapy (%BC): 39] [Respiratory Services/Therapy  (%BC): 39] [Speech Therapy (%BC): 39] [All Other OP (%BC): 39]","count":"22","median_amount":702.45,"10th_percentile":167.84,"90th_percentile":866.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"36","median_amount":1418.62,"10th_percentile":780.94,"90th_percentile":1685.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":566.49,"10th_percentile":566.49,"90th_percentile":566.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Mycare Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"1 through 10","median_amount":1640.58,"10th_percentile":1640.58,"90th_percentile":1640.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 75] [OP Surgery  (%BC): 75] [Observation (%BC): 75] [Emergency Department (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [All Other OP (%BC): 75]","count":"35","median_amount":825.67,"10th_percentile":695.04,"90th_percentile":1440.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72] [OP Surgery  (%BC): 72] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 72] [Physical Therapy (%BC): 72] [Respiratory Services/Therapy  (%BC): 72] [Speech Therapy (%BC): 72] [All Other OP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"11","median_amount":1665.67,"10th_percentile":1584.39,"90th_percentile":2424.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"1 through 10","median_amount":2322.38,"10th_percentile":2322.38,"90th_percentile":2322.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [ED Level 1--99281 ($): 27.09] [ED Level 2--99282 ($): 41.69] [ED Level 3--99283 ($): 73.69] [ED Level 4--99284 ($): 123.51] [ED Level 5--99285 ($): 223.93] [Clinic Visit ($): 59.34] [OP High Cost Drugs (%BC): 40] [Other Outpatient Implant (%BC): 40]","count":"1 through 10","median_amount":531.59,"10th_percentile":531.59,"90th_percentile":531.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"26","median_amount":934.7,"10th_percentile":752.74,"90th_percentile":2872.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":889.13,"10th_percentile":889.13,"90th_percentile":889.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 Imaging with Contrast","code_information":[{"code":"5571","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 84] [OP Surgery  (%BC): 84] [Observation (%BC): 84] [Emergency Department (%BC): 84] [Occupational Therapy (%BC): 84] [Physical Therapy (%BC): 84] [Respiratory Services/Therapy  (%BC): 84] [Speech Therapy (%BC): 84] [All Other OP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41.82] [OP Surgery  (%BC): 41.82] [Observation (%BC): 41.82] [Emergency Department (%BC): 41.82] [Occupational Therapy (%BC): 41.82] [Physical Therapy (%BC): 41.82] [Respiratory Services/Therapy  (%BC): 41.82] [Speech Therapy (%BC): 41.82] [All Other OP (%BC): 41.82]","count":"36","median_amount":1057.23,"10th_percentile":267.83,"90th_percentile":1631.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [All OP services (%BC): 77.4] [OP Surgery  (%BC): 77.4] [Observation (%BC): 77.4] [Emergency Department (%BC): 77.4] [Occupational Therapy (%BC): 77.4] [Physical Therapy (%BC): 77.4] [Respiratory Services/Therapy  (%BC): 77.4] [Speech Therapy (%BC): 77.4] [All Other OP (%BC): 77.4]","count":"62","median_amount":1886.22,"10th_percentile":539.36,"90th_percentile":2776.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"1 through 10","median_amount":1004.05,"10th_percentile":245.76,"90th_percentile":2592.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41] [OP Surgery  (%BC): 41] [Observation (%BC): 41] [Emergency Department (%BC): 41] [Occupational Therapy (%BC): 41] [Physical Therapy (%BC): 41] [Respiratory Services/Therapy  (%BC): 41] [Speech Therapy (%BC): 41] [All Other OP (%BC): 41]","count":"19","median_amount":947.69,"10th_percentile":220.07,"90th_percentile":1625.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 60.6] [OP Surgery  (%BC): 60.6] [Observation (%BC): 60.6] [Emergency Department (%BC): 60.6] [Occupational Therapy (%BC): 60.6] [Physical Therapy (%BC): 60.6] [Respiratory Services/Therapy  (%BC): 60.6] [Speech Therapy (%BC): 60.6] [All Other OP (%BC): 60.6]","count":"1 through 10","median_amount":1508.79,"10th_percentile":1508.79,"90th_percentile":1508.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Bluecard Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":802.34,"10th_percentile":802.34,"90th_percentile":2044.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [Emergency Department ($): 40]","count":"1 through 10","median_amount":612.86,"10th_percentile":592.35,"90th_percentile":724.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 79.2] [OP Surgery  (%BC): 79.2] [Observation (%BC): 79.2] [Emergency Department (%BC): 79.2] [Occupational Therapy (%BC): 79.2] [Physical Therapy (%BC): 79.2] [Respiratory Services/Therapy  (%BC): 79.2] [Speech Therapy (%BC): 79.2] [All Other OP (%BC): 79.2]","count":"1 through 10","median_amount":1180.55,"10th_percentile":1180.55,"90th_percentile":1180.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74] [Observation (%BC): 74] [Emergency Department (%BC): 74] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 74] [Physical Therapy (%BC): 74] [Respiratory Services/Therapy  (%BC): 74] [Speech Therapy (%BC): 74] [All Other OP (%BC): 74]","count":"1 through 10","median_amount":1380.79,"10th_percentile":1380.79,"90th_percentile":1380.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 78] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"1 through 10","median_amount":349.63,"10th_percentile":349.63,"90th_percentile":349.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 39] [OP Surgery  (%BC): 39] [Observation (%BC): 39] [Emergency Department (%BC): 39] [Occupational Therapy (%BC): 39] [Physical Therapy (%BC): 39] [Respiratory Services/Therapy  (%BC): 39] [Speech Therapy (%BC): 39] [All Other OP (%BC): 39]","count":"20","median_amount":603.35,"10th_percentile":259.93,"90th_percentile":1796.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"25","median_amount":1754.21,"10th_percentile":521.61,"90th_percentile":3102.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":610.12,"10th_percentile":610.12,"90th_percentile":610.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Mycare Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 75] [OP Surgery  (%BC): 75] [Observation (%BC): 75] [Emergency Department (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [All Other OP (%BC): 75]","count":"13","median_amount":989.15,"10th_percentile":697.08,"90th_percentile":1748.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72] [OP Surgery  (%BC): 72] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 72] [Physical Therapy (%BC): 72] [Respiratory Services/Therapy  (%BC): 72] [Speech Therapy (%BC): 72] [All Other OP (%BC): 72]","count":"1 through 10","median_amount":1855.73,"10th_percentile":1855.73,"90th_percentile":1855.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"1 through 10","median_amount":2517.56,"10th_percentile":420.5,"90th_percentile":4622.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"1 through 10","median_amount":3560.35,"10th_percentile":1019.55,"90th_percentile":4226.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [ED Level 1--99281 ($): 27.09] [ED Level 2--99282 ($): 41.69] [ED Level 3--99283 ($): 73.69] [ED Level 4--99284 ($): 123.51] [ED Level 5--99285 ($): 223.93] [Clinic Visit ($): 59.34] [OP High Cost Drugs (%BC): 40] [Other Outpatient Implant (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"20","median_amount":1536.91,"10th_percentile":727.72,"90th_percentile":3525.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"1 through 10","median_amount":911.03,"10th_percentile":911.03,"90th_percentile":911.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":687.15,"10th_percentile":687.15,"90th_percentile":2024.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Imaging with Contrast","code_information":[{"code":"5572","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 84] [OP Surgery  (%BC): 84] [Observation (%BC): 84] [Emergency Department (%BC): 84] [Occupational Therapy (%BC): 84] [Physical Therapy (%BC): 84] [Respiratory Services/Therapy  (%BC): 84] [Speech Therapy (%BC): 84] [All Other OP (%BC): 84]","count":"1 through 10","median_amount":2939.54,"10th_percentile":2131.85,"90th_percentile":3583.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":1976.74,"10th_percentile":1976.74,"90th_percentile":1976.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41.82] [OP Surgery  (%BC): 41.82] [Observation (%BC): 41.82] [Emergency Department (%BC): 41.82] [Occupational Therapy (%BC): 41.82] [Physical Therapy (%BC): 41.82] [Respiratory Services/Therapy  (%BC): 41.82] [Speech Therapy (%BC): 41.82] [All Other OP (%BC): 41.82]","count":"47","median_amount":1442.44,"10th_percentile":1066.14,"90th_percentile":1937.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [All OP services (%BC): 77.4] [OP Surgery  (%BC): 77.4] [Observation (%BC): 77.4] [Emergency Department (%BC): 77.4] [Occupational Therapy (%BC): 77.4] [Physical Therapy (%BC): 77.4] [Respiratory Services/Therapy  (%BC): 77.4] [Speech Therapy (%BC): 77.4] [All Other OP (%BC): 77.4]","count":"131","median_amount":2427.14,"10th_percentile":929.32,"90th_percentile":3283.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"1 through 10","median_amount":1508.61,"10th_percentile":1273.74,"90th_percentile":2385.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41] [OP Surgery  (%BC): 41] [Observation (%BC): 41] [Emergency Department (%BC): 41] [Occupational Therapy (%BC): 41] [Physical Therapy (%BC): 41] [Respiratory Services/Therapy  (%BC): 41] [Speech Therapy (%BC): 41] [All Other OP (%BC): 41]","count":"38","median_amount":1341.73,"10th_percentile":964.0,"90th_percentile":1571.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 60.6] [OP Surgery  (%BC): 60.6] [Observation (%BC): 60.6] [Emergency Department (%BC): 60.6] [Occupational Therapy (%BC): 60.6] [Physical Therapy (%BC): 60.6] [Respiratory Services/Therapy  (%BC): 60.6] [Speech Therapy (%BC): 60.6] [All Other OP (%BC): 60.6]","count":"1 through 10","median_amount":2130.6,"10th_percentile":1808.17,"90th_percentile":2661.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Bluecard Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":1147.47,"10th_percentile":1147.47,"90th_percentile":1147.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [Emergency Department ($): 40]","count":"19","median_amount":600.93,"10th_percentile":600.93,"90th_percentile":929.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":898.23,"10th_percentile":600.93,"90th_percentile":929.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 79.2] [OP Surgery  (%BC): 79.2] [Observation (%BC): 79.2] [Emergency Department (%BC): 79.2] [Occupational Therapy (%BC): 79.2] [Physical Therapy (%BC): 79.2] [Respiratory Services/Therapy  (%BC): 79.2] [Speech Therapy (%BC): 79.2] [All Other OP (%BC): 79.2]","count":"1 through 10","median_amount":3262.4,"10th_percentile":3262.4,"90th_percentile":3262.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74] [Observation (%BC): 74] [Emergency Department (%BC): 74] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 74] [Physical Therapy (%BC): 74] [Respiratory Services/Therapy  (%BC): 74] [Speech Therapy (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 78] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"1 through 10","median_amount":793.65,"10th_percentile":630.98,"90th_percentile":975.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 39] [OP Surgery  (%BC): 39] [Observation (%BC): 39] [Emergency Department (%BC): 39] [Occupational Therapy (%BC): 39] [Physical Therapy (%BC): 39] [Respiratory Services/Therapy  (%BC): 39] [Speech Therapy (%BC): 39] [All Other OP (%BC): 39]","count":"33","median_amount":1138.78,"10th_percentile":394.25,"90th_percentile":1583.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"62","median_amount":2482.86,"10th_percentile":1322.03,"90th_percentile":3213.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":618.96,"10th_percentile":618.96,"90th_percentile":618.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Mycare Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 75] [OP Surgery  (%BC): 75] [Observation (%BC): 75] [Emergency Department (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [All Other OP (%BC): 75]","count":"35","median_amount":1334.86,"10th_percentile":908.49,"90th_percentile":2639.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72] [OP Surgery  (%BC): 72] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 72] [Physical Therapy (%BC): 72] [Respiratory Services/Therapy  (%BC): 72] [Speech Therapy (%BC): 72] [All Other OP (%BC): 72]","count":"1 through 10","median_amount":1756.85,"10th_percentile":1756.85,"90th_percentile":1756.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"13","median_amount":3051.46,"10th_percentile":2283.95,"90th_percentile":5824.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"1 through 10","median_amount":3202.71,"10th_percentile":2171.61,"90th_percentile":3450.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [ED Level 1--99281 ($): 27.09] [ED Level 2--99282 ($): 41.69] [ED Level 3--99283 ($): 73.69] [ED Level 4--99284 ($): 123.51] [ED Level 5--99285 ($): 223.93] [Clinic Visit ($): 59.34] [OP High Cost Drugs (%BC): 40] [Other Outpatient Implant (%BC): 40]","count":"1 through 10","median_amount":929.32,"10th_percentile":600.93,"90th_percentile":929.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"34","median_amount":1741.81,"10th_percentile":1361.54,"90th_percentile":3639.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"1 through 10","median_amount":1277.53,"10th_percentile":1277.53,"90th_percentile":1335.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":1357.35,"10th_percentile":1279.46,"90th_percentile":1557.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Imaging with Contrast","code_information":[{"code":"5573","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 84] [OP Surgery  (%BC): 84] [Observation (%BC): 84] [Emergency Department (%BC): 84] [Occupational Therapy (%BC): 84] [Physical Therapy (%BC): 84] [Respiratory Services/Therapy  (%BC): 84] [Speech Therapy (%BC): 84] [All Other OP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41.82] [OP Surgery  (%BC): 41.82] [Observation (%BC): 41.82] [Emergency Department (%BC): 41.82] [Occupational Therapy (%BC): 41.82] [Physical Therapy (%BC): 41.82] [Respiratory Services/Therapy  (%BC): 41.82] [Speech Therapy (%BC): 41.82] [All Other OP (%BC): 41.82]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [All OP services (%BC): 77.4] [OP Surgery  (%BC): 77.4] [Observation (%BC): 77.4] [Emergency Department (%BC): 77.4] [Occupational Therapy (%BC): 77.4] [Physical Therapy (%BC): 77.4] [Respiratory Services/Therapy  (%BC): 77.4] [Speech Therapy (%BC): 77.4] [All Other OP (%BC): 77.4]","count":"1 through 10","median_amount":2310.97,"10th_percentile":2214.53,"90th_percentile":3174.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41] [OP Surgery  (%BC): 41] [Observation (%BC): 41] [Emergency Department (%BC): 41] [Occupational Therapy (%BC): 41] [Physical Therapy (%BC): 41] [Respiratory Services/Therapy  (%BC): 41] [Speech Therapy (%BC): 41] [All Other OP (%BC): 41]","count":"1 through 10","median_amount":1507.28,"10th_percentile":1507.28,"90th_percentile":1507.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 60.6] [OP Surgery  (%BC): 60.6] [Observation (%BC): 60.6] [Emergency Department (%BC): 60.6] [Occupational Therapy (%BC): 60.6] [Physical Therapy (%BC): 60.6] [Respiratory Services/Therapy  (%BC): 60.6] [Speech Therapy (%BC): 60.6] [All Other OP (%BC): 60.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Bluecard Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [Emergency Department ($): 40]","count":"1 through 10","median_amount":903.94,"10th_percentile":873.69,"90th_percentile":903.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 79.2] [OP Surgery  (%BC): 79.2] [Observation (%BC): 79.2] [Emergency Department (%BC): 79.2] [Occupational Therapy (%BC): 79.2] [Physical Therapy (%BC): 79.2] [Respiratory Services/Therapy  (%BC): 79.2] [Speech Therapy (%BC): 79.2] [All Other OP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74] [Observation (%BC): 74] [Emergency Department (%BC): 74] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 74] [Physical Therapy (%BC): 74] [Respiratory Services/Therapy  (%BC): 74] [Speech Therapy (%BC): 74] [All Other OP (%BC): 74]","count":"1 through 10","median_amount":2197.81,"10th_percentile":2197.81,"90th_percentile":2197.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 78] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"1 through 10","median_amount":917.38,"10th_percentile":917.38,"90th_percentile":917.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 39] [OP Surgery  (%BC): 39] [Observation (%BC): 39] [Emergency Department (%BC): 39] [Occupational Therapy (%BC): 39] [Physical Therapy (%BC): 39] [Respiratory Services/Therapy  (%BC): 39] [Speech Therapy (%BC): 39] [All Other OP (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"1 through 10","median_amount":2182.97,"10th_percentile":2182.97,"90th_percentile":2944.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Mycare Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 75] [OP Surgery  (%BC): 75] [Observation (%BC): 75] [Emergency Department (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [All Other OP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72] [OP Surgery  (%BC): 72] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 72] [Physical Therapy (%BC): 72] [Respiratory Services/Therapy  (%BC): 72] [Speech Therapy (%BC): 72] [All Other OP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [ED Level 1--99281 ($): 27.09] [ED Level 2--99282 ($): 41.69] [ED Level 3--99283 ($): 73.69] [ED Level 4--99284 ($): 123.51] [ED Level 5--99285 ($): 223.93] [Clinic Visit ($): 59.34] [OP High Cost Drugs (%BC): 40] [Other Outpatient Implant (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Nuclear Medicine and Related Services","code_information":[{"code":"5591","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 84] [OP Surgery  (%BC): 84] [Observation (%BC): 84] [Emergency Department (%BC): 84] [Occupational Therapy (%BC): 84] [Physical Therapy (%BC): 84] [Respiratory Services/Therapy  (%BC): 84] [Speech Therapy (%BC): 84] [All Other OP (%BC): 84]","count":"1 through 10","median_amount":2327.73,"10th_percentile":2327.73,"90th_percentile":2327.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":912.2,"10th_percentile":912.2,"90th_percentile":1127.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41.82] [OP Surgery  (%BC): 41.82] [Observation (%BC): 41.82] [Emergency Department (%BC): 41.82] [Occupational Therapy (%BC): 41.82] [Physical Therapy (%BC): 41.82] [Respiratory Services/Therapy  (%BC): 41.82] [Speech Therapy (%BC): 41.82] [All Other OP (%BC): 41.82]","count":"23","median_amount":994.08,"10th_percentile":679.31,"90th_percentile":1704.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [All OP services (%BC): 77.4] [OP Surgery  (%BC): 77.4] [Observation (%BC): 77.4] [Emergency Department (%BC): 77.4] [Occupational Therapy (%BC): 77.4] [Physical Therapy (%BC): 77.4] [Respiratory Services/Therapy  (%BC): 77.4] [Speech Therapy (%BC): 77.4] [All Other OP (%BC): 77.4]","count":"13","median_amount":1818.56,"10th_percentile":484.61,"90th_percentile":3113.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"1 through 10","median_amount":959.0,"10th_percentile":959.0,"90th_percentile":959.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41] [OP Surgery  (%BC): 41] [Observation (%BC): 41] [Emergency Department (%BC): 41] [Occupational Therapy (%BC): 41] [Physical Therapy (%BC): 41] [Respiratory Services/Therapy  (%BC): 41] [Speech Therapy (%BC): 41] [All Other OP (%BC): 41]","count":"1 through 10","median_amount":2393.27,"10th_percentile":656.4,"90th_percentile":3441.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 60.6] [OP Surgery  (%BC): 60.6] [Observation (%BC): 60.6] [Emergency Department (%BC): 60.6] [Occupational Therapy (%BC): 60.6] [Physical Therapy (%BC): 60.6] [Respiratory Services/Therapy  (%BC): 60.6] [Speech Therapy (%BC): 60.6] [All Other OP (%BC): 60.6]","count":"1 through 10","median_amount":1436.17,"10th_percentile":1436.17,"90th_percentile":1436.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Bluecard Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [Emergency Department ($): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 79.2] [OP Surgery  (%BC): 79.2] [Observation (%BC): 79.2] [Emergency Department (%BC): 79.2] [Occupational Therapy (%BC): 79.2] [Physical Therapy (%BC): 79.2] [Respiratory Services/Therapy  (%BC): 79.2] [Speech Therapy (%BC): 79.2] [All Other OP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74] [Observation (%BC): 74] [Emergency Department (%BC): 74] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 74] [Physical Therapy (%BC): 74] [Respiratory Services/Therapy  (%BC): 74] [Speech Therapy (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 78] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 39] [OP Surgery  (%BC): 39] [Observation (%BC): 39] [Emergency Department (%BC): 39] [Occupational Therapy (%BC): 39] [Physical Therapy (%BC): 39] [Respiratory Services/Therapy  (%BC): 39] [Speech Therapy (%BC): 39] [All Other OP (%BC): 39]","count":"1 through 10","median_amount":703.56,"10th_percentile":679.82,"90th_percentile":1103.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"1 through 10","median_amount":1936.01,"10th_percentile":1265.63,"90th_percentile":4227.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Mycare Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 75] [OP Surgery  (%BC): 75] [Observation (%BC): 75] [Emergency Department (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [All Other OP (%BC): 75]","count":"1 through 10","median_amount":1397.9,"10th_percentile":393.2,"90th_percentile":1513.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72] [OP Surgery  (%BC): 72] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 72] [Physical Therapy (%BC): 72] [Respiratory Services/Therapy  (%BC): 72] [Speech Therapy (%BC): 72] [All Other OP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"1 through 10","median_amount":2162.24,"10th_percentile":1624.61,"90th_percentile":3514.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"1 through 10","median_amount":1491.06,"10th_percentile":1491.06,"90th_percentile":1491.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [ED Level 1--99281 ($): 27.09] [ED Level 2--99282 ($): 41.69] [ED Level 3--99283 ($): 73.69] [ED Level 4--99284 ($): 123.51] [ED Level 5--99285 ($): 223.93] [Clinic Visit ($): 59.34] [OP High Cost Drugs (%BC): 40] [Other Outpatient Implant (%BC): 40]","count":"1 through 10","median_amount":484.61,"10th_percentile":484.61,"90th_percentile":484.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Nuclear Medicine and Related Services","code_information":[{"code":"5592","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 84] [OP Surgery  (%BC): 84] [Observation (%BC): 84] [Emergency Department (%BC): 84] [Occupational Therapy (%BC): 84] [Physical Therapy (%BC): 84] [Respiratory Services/Therapy  (%BC): 84] [Speech Therapy (%BC): 84] [All Other OP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41.82] [OP Surgery  (%BC): 41.82] [Observation (%BC): 41.82] [Emergency Department (%BC): 41.82] [Occupational Therapy (%BC): 41.82] [Physical Therapy (%BC): 41.82] [Respiratory Services/Therapy  (%BC): 41.82] [Speech Therapy (%BC): 41.82] [All Other OP (%BC): 41.82]","count":"1 through 10","median_amount":994.8,"10th_percentile":930.31,"90th_percentile":1773.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [All OP services (%BC): 77.4] [OP Surgery  (%BC): 77.4] [Observation (%BC): 77.4] [Emergency Department (%BC): 77.4] [Occupational Therapy (%BC): 77.4] [Physical Therapy (%BC): 77.4] [Respiratory Services/Therapy  (%BC): 77.4] [Speech Therapy (%BC): 77.4] [All Other OP (%BC): 77.4]","count":"17","median_amount":1276.92,"10th_percentile":105.13,"90th_percentile":2079.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41] [OP Surgery  (%BC): 41] [Observation (%BC): 41] [Emergency Department (%BC): 41] [Occupational Therapy (%BC): 41] [Physical Therapy (%BC): 41] [Respiratory Services/Therapy  (%BC): 41] [Speech Therapy (%BC): 41] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 60.6] [OP Surgery  (%BC): 60.6] [Observation (%BC): 60.6] [Emergency Department (%BC): 60.6] [Occupational Therapy (%BC): 60.6] [Physical Therapy (%BC): 60.6] [Respiratory Services/Therapy  (%BC): 60.6] [Speech Therapy (%BC): 60.6] [All Other OP (%BC): 60.6]","count":"1 through 10","median_amount":1388.46,"10th_percentile":1388.46,"90th_percentile":1388.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Bluecard Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [Emergency Department ($): 40]","count":"1 through 10","median_amount":617.86,"10th_percentile":617.86,"90th_percentile":617.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 79.2] [OP Surgery  (%BC): 79.2] [Observation (%BC): 79.2] [Emergency Department (%BC): 79.2] [Occupational Therapy (%BC): 79.2] [Physical Therapy (%BC): 79.2] [Respiratory Services/Therapy  (%BC): 79.2] [Speech Therapy (%BC): 79.2] [All Other OP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74] [Observation (%BC): 74] [Emergency Department (%BC): 74] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 74] [Physical Therapy (%BC): 74] [Respiratory Services/Therapy  (%BC): 74] [Speech Therapy (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 78] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"1 through 10","median_amount":648.75,"10th_percentile":648.75,"90th_percentile":648.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 39] [OP Surgery  (%BC): 39] [Observation (%BC): 39] [Emergency Department (%BC): 39] [Occupational Therapy (%BC): 39] [Physical Therapy (%BC): 39] [Respiratory Services/Therapy  (%BC): 39] [Speech Therapy (%BC): 39] [All Other OP (%BC): 39]","count":"1 through 10","median_amount":676.3,"10th_percentile":676.3,"90th_percentile":676.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"1 through 10","median_amount":1454.46,"10th_percentile":1454.46,"90th_percentile":2146.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":655.79,"10th_percentile":655.79,"90th_percentile":655.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Mycare Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 75] [OP Surgery  (%BC): 75] [Observation (%BC): 75] [Emergency Department (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [All Other OP (%BC): 75]","count":"1 through 10","median_amount":956.38,"10th_percentile":956.38,"90th_percentile":1376.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72] [OP Surgery  (%BC): 72] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 72] [Physical Therapy (%BC): 72] [Respiratory Services/Therapy  (%BC): 72] [Speech Therapy (%BC): 72] [All Other OP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"1 through 10","median_amount":2451.4,"10th_percentile":2451.4,"90th_percentile":2451.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [ED Level 1--99281 ($): 27.09] [ED Level 2--99282 ($): 41.69] [ED Level 3--99283 ($): 73.69] [ED Level 4--99284 ($): 123.51] [ED Level 5--99285 ($): 223.93] [Clinic Visit ($): 59.34] [OP High Cost Drugs (%BC): 40] [Other Outpatient Implant (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"1 through 10","median_amount":1063.82,"10th_percentile":1063.82,"90th_percentile":1063.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Nuclear Medicine and Related Services","code_information":[{"code":"5593","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 84] [OP Surgery  (%BC): 84] [Observation (%BC): 84] [Emergency Department (%BC): 84] [Occupational Therapy (%BC): 84] [Physical Therapy (%BC): 84] [Respiratory Services/Therapy  (%BC): 84] [Speech Therapy (%BC): 84] [All Other OP (%BC): 84]","count":"1 through 10","median_amount":4737.75,"10th_percentile":4535.17,"90th_percentile":5418.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":2375.18,"10th_percentile":2375.18,"90th_percentile":2375.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41.82] [OP Surgery  (%BC): 41.82] [Observation (%BC): 41.82] [Emergency Department (%BC): 41.82] [Occupational Therapy (%BC): 41.82] [Physical Therapy (%BC): 41.82] [Respiratory Services/Therapy  (%BC): 41.82] [Speech Therapy (%BC): 41.82] [All Other OP (%BC): 41.82]","count":"22","median_amount":2390.73,"10th_percentile":2149.07,"90th_percentile":3050.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [All OP services (%BC): 77.4] [OP Surgery  (%BC): 77.4] [Observation (%BC): 77.4] [Emergency Department (%BC): 77.4] [Occupational Therapy (%BC): 77.4] [Physical Therapy (%BC): 77.4] [Respiratory Services/Therapy  (%BC): 77.4] [Speech Therapy (%BC): 77.4] [All Other OP (%BC): 77.4]","count":"47","median_amount":4492.88,"10th_percentile":1500.27,"90th_percentile":6015.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"1 through 10","median_amount":2267.81,"10th_percentile":2267.81,"90th_percentile":2282.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41] [OP Surgery  (%BC): 41] [Observation (%BC): 41] [Emergency Department (%BC): 41] [Occupational Therapy (%BC): 41] [Physical Therapy (%BC): 41] [Respiratory Services/Therapy  (%BC): 41] [Speech Therapy (%BC): 41] [All Other OP (%BC): 41]","count":"17","median_amount":2267.81,"10th_percentile":2074.59,"90th_percentile":3069.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 60.6] [OP Surgery  (%BC): 60.6] [Observation (%BC): 60.6] [Emergency Department (%BC): 60.6] [Occupational Therapy (%BC): 60.6] [Physical Therapy (%BC): 60.6] [Respiratory Services/Therapy  (%BC): 60.6] [Speech Therapy (%BC): 60.6] [All Other OP (%BC): 60.6]","count":"1 through 10","median_amount":3519.14,"10th_percentile":3519.14,"90th_percentile":3903.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Bluecard Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":2306.95,"10th_percentile":2306.95,"90th_percentile":2306.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [Emergency Department ($): 40]","count":"1 through 10","median_amount":1552.19,"10th_percentile":1552.19,"90th_percentile":1552.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":1812.02,"10th_percentile":1812.02,"90th_percentile":1812.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 79.2] [OP Surgery  (%BC): 79.2] [Observation (%BC): 79.2] [Emergency Department (%BC): 79.2] [Occupational Therapy (%BC): 79.2] [Physical Therapy (%BC): 79.2] [Respiratory Services/Therapy  (%BC): 79.2] [Speech Therapy (%BC): 79.2] [All Other OP (%BC): 79.2]","count":"1 through 10","median_amount":4545.21,"10th_percentile":4545.21,"90th_percentile":4545.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74] [Observation (%BC): 74] [Emergency Department (%BC): 74] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 74] [Physical Therapy (%BC): 74] [Respiratory Services/Therapy  (%BC): 74] [Speech Therapy (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 78] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"1 through 10","median_amount":1918.54,"10th_percentile":1918.54,"90th_percentile":1918.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 39] [OP Surgery  (%BC): 39] [Observation (%BC): 39] [Emergency Department (%BC): 39] [Occupational Therapy (%BC): 39] [Physical Therapy (%BC): 39] [Respiratory Services/Therapy  (%BC): 39] [Speech Therapy (%BC): 39] [All Other OP (%BC): 39]","count":"17","median_amount":2295.37,"10th_percentile":2205.42,"90th_percentile":2468.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"19","median_amount":4185.4,"10th_percentile":2146.12,"90th_percentile":5932.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":1424.74,"10th_percentile":1424.74,"90th_percentile":1424.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Mycare Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 75] [OP Surgery  (%BC): 75] [Observation (%BC): 75] [Emergency Department (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [All Other OP (%BC): 75]","count":"22","median_amount":2345.92,"10th_percentile":2066.21,"90th_percentile":4283.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72] [OP Surgery  (%BC): 72] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 72] [Physical Therapy (%BC): 72] [Respiratory Services/Therapy  (%BC): 72] [Speech Therapy (%BC): 72] [All Other OP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"1 through 10","median_amount":5620.6,"10th_percentile":5490.22,"90th_percentile":7317.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"1 through 10","median_amount":5639.64,"10th_percentile":5639.64,"90th_percentile":5639.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [ED Level 1--99281 ($): 27.09] [ED Level 2--99282 ($): 41.69] [ED Level 3--99283 ($): 73.69] [ED Level 4--99284 ($): 123.51] [ED Level 5--99285 ($): 223.93] [Clinic Visit ($): 59.34] [OP High Cost Drugs (%BC): 40] [Other Outpatient Implant (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"14","median_amount":2832.44,"10th_percentile":2540.02,"90th_percentile":5050.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":2230.59,"10th_percentile":2230.59,"90th_percentile":2230.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 4 Nuclear Medicine and Related Services","code_information":[{"code":"5594","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 84] [OP Surgery  (%BC): 84] [Observation (%BC): 84] [Emergency Department (%BC): 84] [Occupational Therapy (%BC): 84] [Physical Therapy (%BC): 84] [Respiratory Services/Therapy  (%BC): 84] [Speech Therapy (%BC): 84] [All Other OP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41.82] [OP Surgery  (%BC): 41.82] [Observation (%BC): 41.82] [Emergency Department (%BC): 41.82] [Occupational Therapy (%BC): 41.82] [Physical Therapy (%BC): 41.82] [Respiratory Services/Therapy  (%BC): 41.82] [Speech Therapy (%BC): 41.82] [All Other OP (%BC): 41.82]","count":"1 through 10","median_amount":1999.05,"10th_percentile":1843.2,"90th_percentile":2314.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [All OP services (%BC): 77.4] [OP Surgery  (%BC): 77.4] [Observation (%BC): 77.4] [Emergency Department (%BC): 77.4] [Occupational Therapy (%BC): 77.4] [Physical Therapy (%BC): 77.4] [Respiratory Services/Therapy  (%BC): 77.4] [Speech Therapy (%BC): 77.4] [All Other OP (%BC): 77.4]","count":"1 through 10","median_amount":3267.31,"10th_percentile":1556.86,"90th_percentile":4590.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"1 through 10","median_amount":1866.86,"10th_percentile":1866.86,"90th_percentile":1866.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41] [OP Surgery  (%BC): 41] [Observation (%BC): 41] [Emergency Department (%BC): 41] [Occupational Therapy (%BC): 41] [Physical Therapy (%BC): 41] [Respiratory Services/Therapy  (%BC): 41] [Speech Therapy (%BC): 41] [All Other OP (%BC): 41]","count":"11","median_amount":1865.18,"10th_percentile":1770.92,"90th_percentile":2115.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 60.6] [OP Surgery  (%BC): 60.6] [Observation (%BC): 60.6] [Emergency Department (%BC): 60.6] [Occupational Therapy (%BC): 60.6] [Physical Therapy (%BC): 60.6] [Respiratory Services/Therapy  (%BC): 60.6] [Speech Therapy (%BC): 60.6] [All Other OP (%BC): 60.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Bluecard Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":1770.94,"10th_percentile":1770.94,"90th_percentile":1770.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [Emergency Department ($): 40]","count":"1 through 10","median_amount":1822.02,"10th_percentile":1822.02,"90th_percentile":1822.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 79.2] [OP Surgery  (%BC): 79.2] [Observation (%BC): 79.2] [Emergency Department (%BC): 79.2] [Occupational Therapy (%BC): 79.2] [Physical Therapy (%BC): 79.2] [Respiratory Services/Therapy  (%BC): 79.2] [Speech Therapy (%BC): 79.2] [All Other OP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74] [Observation (%BC): 74] [Emergency Department (%BC): 74] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 74] [Physical Therapy (%BC): 74] [Respiratory Services/Therapy  (%BC): 74] [Speech Therapy (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 78] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 39] [OP Surgery  (%BC): 39] [Observation (%BC): 39] [Emergency Department (%BC): 39] [Occupational Therapy (%BC): 39] [Physical Therapy (%BC): 39] [Respiratory Services/Therapy  (%BC): 39] [Speech Therapy (%BC): 39] [All Other OP (%BC): 39]","count":"1 through 10","median_amount":1783.42,"10th_percentile":1783.42,"90th_percentile":3060.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"1 through 10","median_amount":2023.06,"10th_percentile":1915.05,"90th_percentile":5612.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Mycare Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 75] [OP Surgery  (%BC): 75] [Observation (%BC): 75] [Emergency Department (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [All Other OP (%BC): 75]","count":"1 through 10","median_amount":2113.53,"10th_percentile":2113.53,"90th_percentile":2113.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72] [OP Surgery  (%BC): 72] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 72] [Physical Therapy (%BC): 72] [Respiratory Services/Therapy  (%BC): 72] [Speech Therapy (%BC): 72] [All Other OP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"1 through 10","median_amount":4229.11,"10th_percentile":4229.11,"90th_percentile":4229.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [ED Level 1--99281 ($): 27.09] [ED Level 2--99282 ($): 41.69] [ED Level 3--99283 ($): 73.69] [ED Level 4--99284 ($): 123.51] [ED Level 5--99285 ($): 223.93] [Clinic Visit ($): 59.34] [OP High Cost Drugs (%BC): 40] [Other Outpatient Implant (%BC): 40]","count":"1 through 10","median_amount":1822.02,"10th_percentile":1822.02,"90th_percentile":1822.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"1 through 10","median_amount":4297.87,"10th_percentile":1999.77,"90th_percentile":4785.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"1 through 10","median_amount":357.72,"10th_percentile":357.72,"90th_percentile":357.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":1966.76,"10th_percentile":1966.76,"90th_percentile":1966.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 Pathology","code_information":[{"code":"5671","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 84] [OP Surgery  (%BC): 84] [Observation (%BC): 84] [Emergency Department (%BC): 84] [Occupational Therapy (%BC): 84] [Physical Therapy (%BC): 84] [Respiratory Services/Therapy  (%BC): 84] [Speech Therapy (%BC): 84] [All Other OP (%BC): 84]","count":"1 through 10","median_amount":299.52,"10th_percentile":299.52,"90th_percentile":2291.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41.82] [OP Surgery  (%BC): 41.82] [Observation (%BC): 41.82] [Emergency Department (%BC): 41.82] [Occupational Therapy (%BC): 41.82] [Physical Therapy (%BC): 41.82] [Respiratory Services/Therapy  (%BC): 41.82] [Speech Therapy (%BC): 41.82] [All Other OP (%BC): 41.82]","count":"1 through 10","median_amount":23855.44,"10th_percentile":23855.44,"90th_percentile":23855.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [All OP services (%BC): 77.4] [OP Surgery  (%BC): 77.4] [Observation (%BC): 77.4] [Emergency Department (%BC): 77.4] [Occupational Therapy (%BC): 77.4] [Physical Therapy (%BC): 77.4] [Respiratory Services/Therapy  (%BC): 77.4] [Speech Therapy (%BC): 77.4] [All Other OP (%BC): 77.4]","count":"22","median_amount":318.04,"10th_percentile":185.89,"90th_percentile":1868.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41] [OP Surgery  (%BC): 41] [Observation (%BC): 41] [Emergency Department (%BC): 41] [Occupational Therapy (%BC): 41] [Physical Therapy (%BC): 41] [Respiratory Services/Therapy  (%BC): 41] [Speech Therapy (%BC): 41] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 60.6] [OP Surgery  (%BC): 60.6] [Observation (%BC): 60.6] [Emergency Department (%BC): 60.6] [Occupational Therapy (%BC): 60.6] [Physical Therapy (%BC): 60.6] [Respiratory Services/Therapy  (%BC): 60.6] [Speech Therapy (%BC): 60.6] [All Other OP (%BC): 60.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Bluecard Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [Emergency Department ($): 40]","count":"1 through 10","median_amount":58.2,"10th_percentile":58.2,"90th_percentile":75.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 79.2] [OP Surgery  (%BC): 79.2] [Observation (%BC): 79.2] [Emergency Department (%BC): 79.2] [Occupational Therapy (%BC): 79.2] [Physical Therapy (%BC): 79.2] [Respiratory Services/Therapy  (%BC): 79.2] [Speech Therapy (%BC): 79.2] [All Other OP (%BC): 79.2]","count":"1 through 10","median_amount":1425.6,"10th_percentile":1425.6,"90th_percentile":2971.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74] [Observation (%BC): 74] [Emergency Department (%BC): 74] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 74] [Physical Therapy (%BC): 74] [Respiratory Services/Therapy  (%BC): 74] [Speech Therapy (%BC): 74] [All Other OP (%BC): 74]","count":"1 through 10","median_amount":266.4,"10th_percentile":266.4,"90th_percentile":25532.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 78] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"1 through 10","median_amount":61.11,"10th_percentile":61.11,"90th_percentile":141.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 39] [OP Surgery  (%BC): 39] [Observation (%BC): 39] [Emergency Department (%BC): 39] [Occupational Therapy (%BC): 39] [Physical Therapy (%BC): 39] [Respiratory Services/Therapy  (%BC): 39] [Speech Therapy (%BC): 39] [All Other OP (%BC): 39]","count":"1 through 10","median_amount":216.02,"10th_percentile":216.02,"90th_percentile":223.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"1 through 10","median_amount":264.6,"10th_percentile":173.17,"90th_percentile":2205.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Mycare Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 75] [OP Surgery  (%BC): 75] [Observation (%BC): 75] [Emergency Department (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [All Other OP (%BC): 75]","count":"1 through 10","median_amount":194.4,"10th_percentile":194.4,"90th_percentile":194.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72] [OP Surgery  (%BC): 72] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 72] [Physical Therapy (%BC): 72] [Respiratory Services/Therapy  (%BC): 72] [Speech Therapy (%BC): 72] [All Other OP (%BC): 72]","count":"1 through 10","median_amount":3472.86,"10th_percentile":3472.86,"90th_percentile":3472.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [ED Level 1--99281 ($): 27.09] [ED Level 2--99282 ($): 41.69] [ED Level 3--99283 ($): 73.69] [ED Level 4--99284 ($): 123.51] [ED Level 5--99285 ($): 223.93] [Clinic Visit ($): 59.34] [OP High Cost Drugs (%BC): 40] [Other Outpatient Implant (%BC): 40]","count":"1 through 10","median_amount":56.26,"10th_percentile":56.26,"90th_percentile":56.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"1 through 10","median_amount":169.14,"10th_percentile":169.14,"90th_percentile":169.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Pathology","code_information":[{"code":"5672","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 84] [OP Surgery  (%BC): 84] [Observation (%BC): 84] [Emergency Department (%BC): 84] [Occupational Therapy (%BC): 84] [Physical Therapy (%BC): 84] [Respiratory Services/Therapy  (%BC): 84] [Speech Therapy (%BC): 84] [All Other OP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41.82] [OP Surgery  (%BC): 41.82] [Observation (%BC): 41.82] [Emergency Department (%BC): 41.82] [Occupational Therapy (%BC): 41.82] [Physical Therapy (%BC): 41.82] [Respiratory Services/Therapy  (%BC): 41.82] [Speech Therapy (%BC): 41.82] [All Other OP (%BC): 41.82]","count":"1 through 10","median_amount":19817.38,"10th_percentile":19817.38,"90th_percentile":19817.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [All OP services (%BC): 77.4] [OP Surgery  (%BC): 77.4] [Observation (%BC): 77.4] [Emergency Department (%BC): 77.4] [Occupational Therapy (%BC): 77.4] [Physical Therapy (%BC): 77.4] [Respiratory Services/Therapy  (%BC): 77.4] [Speech Therapy (%BC): 77.4] [All Other OP (%BC): 77.4]","count":"1 through 10","median_amount":218.12,"10th_percentile":218.12,"90th_percentile":484.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41] [OP Surgery  (%BC): 41] [Observation (%BC): 41] [Emergency Department (%BC): 41] [Occupational Therapy (%BC): 41] [Physical Therapy (%BC): 41] [Respiratory Services/Therapy  (%BC): 41] [Speech Therapy (%BC): 41] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 60.6] [OP Surgery  (%BC): 60.6] [Observation (%BC): 60.6] [Emergency Department (%BC): 60.6] [Occupational Therapy (%BC): 60.6] [Physical Therapy (%BC): 60.6] [Respiratory Services/Therapy  (%BC): 60.6] [Speech Therapy (%BC): 60.6] [All Other OP (%BC): 60.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Bluecard Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":356.66,"10th_percentile":356.66,"90th_percentile":356.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [Emergency Department ($): 40]","count":"1 through 10","median_amount":218.12,"10th_percentile":218.12,"90th_percentile":218.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":218.12,"10th_percentile":218.12,"90th_percentile":218.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 79.2] [OP Surgery  (%BC): 79.2] [Observation (%BC): 79.2] [Emergency Department (%BC): 79.2] [Occupational Therapy (%BC): 79.2] [Physical Therapy (%BC): 79.2] [Respiratory Services/Therapy  (%BC): 79.2] [Speech Therapy (%BC): 79.2] [All Other OP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74] [Observation (%BC): 74] [Emergency Department (%BC): 74] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 74] [Physical Therapy (%BC): 74] [Respiratory Services/Therapy  (%BC): 74] [Speech Therapy (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 78] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"1 through 10","median_amount":221.37,"10th_percentile":221.37,"90th_percentile":221.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 39] [OP Surgery  (%BC): 39] [Observation (%BC): 39] [Emergency Department (%BC): 39] [Occupational Therapy (%BC): 39] [Physical Therapy (%BC): 39] [Respiratory Services/Therapy  (%BC): 39] [Speech Therapy (%BC): 39] [All Other OP (%BC): 39]","count":"1 through 10","median_amount":813.63,"10th_percentile":813.63,"90th_percentile":813.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"1 through 10","median_amount":925.99,"10th_percentile":925.99,"90th_percentile":925.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Mycare Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 75] [OP Surgery  (%BC): 75] [Observation (%BC): 75] [Emergency Department (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [All Other OP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72] [OP Surgery  (%BC): 72] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 72] [Physical Therapy (%BC): 72] [Respiratory Services/Therapy  (%BC): 72] [Speech Therapy (%BC): 72] [All Other OP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [ED Level 1--99281 ($): 27.09] [ED Level 2--99282 ($): 41.69] [ED Level 3--99283 ($): 73.69] [ED Level 4--99284 ($): 123.51] [ED Level 5--99285 ($): 223.93] [Clinic Visit ($): 59.34] [OP High Cost Drugs (%BC): 40] [Other Outpatient Implant (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Pathology","code_information":[{"code":"5673","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 84] [OP Surgery  (%BC): 84] [Observation (%BC): 84] [Emergency Department (%BC): 84] [Occupational Therapy (%BC): 84] [Physical Therapy (%BC): 84] [Respiratory Services/Therapy  (%BC): 84] [Speech Therapy (%BC): 84] [All Other OP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41.82] [OP Surgery  (%BC): 41.82] [Observation (%BC): 41.82] [Emergency Department (%BC): 41.82] [Occupational Therapy (%BC): 41.82] [Physical Therapy (%BC): 41.82] [Respiratory Services/Therapy  (%BC): 41.82] [Speech Therapy (%BC): 41.82] [All Other OP (%BC): 41.82]","count":"1 through 10","median_amount":3886.29,"10th_percentile":3886.29,"90th_percentile":3886.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [All OP services (%BC): 77.4] [OP Surgery  (%BC): 77.4] [Observation (%BC): 77.4] [Emergency Department (%BC): 77.4] [Occupational Therapy (%BC): 77.4] [Physical Therapy (%BC): 77.4] [Respiratory Services/Therapy  (%BC): 77.4] [Speech Therapy (%BC): 77.4] [All Other OP (%BC): 77.4]","count":"1 through 10","median_amount":873.55,"10th_percentile":873.55,"90th_percentile":873.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41] [OP Surgery  (%BC): 41] [Observation (%BC): 41] [Emergency Department (%BC): 41] [Occupational Therapy (%BC): 41] [Physical Therapy (%BC): 41] [Respiratory Services/Therapy  (%BC): 41] [Speech Therapy (%BC): 41] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 60.6] [OP Surgery  (%BC): 60.6] [Observation (%BC): 60.6] [Emergency Department (%BC): 60.6] [Occupational Therapy (%BC): 60.6] [Physical Therapy (%BC): 60.6] [Respiratory Services/Therapy  (%BC): 60.6] [Speech Therapy (%BC): 60.6] [All Other OP (%BC): 60.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Bluecard Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [Emergency Department ($): 40]","count":"1 through 10","median_amount":488.6,"10th_percentile":488.6,"90th_percentile":488.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 79.2] [OP Surgery  (%BC): 79.2] [Observation (%BC): 79.2] [Emergency Department (%BC): 79.2] [Occupational Therapy (%BC): 79.2] [Physical Therapy (%BC): 79.2] [Respiratory Services/Therapy  (%BC): 79.2] [Speech Therapy (%BC): 79.2] [All Other OP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74] [Observation (%BC): 74] [Emergency Department (%BC): 74] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 74] [Physical Therapy (%BC): 74] [Respiratory Services/Therapy  (%BC): 74] [Speech Therapy (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 78] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 39] [OP Surgery  (%BC): 39] [Observation (%BC): 39] [Emergency Department (%BC): 39] [Occupational Therapy (%BC): 39] [Physical Therapy (%BC): 39] [Respiratory Services/Therapy  (%BC): 39] [Speech Therapy (%BC): 39] [All Other OP (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Mycare Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 75] [OP Surgery  (%BC): 75] [Observation (%BC): 75] [Emergency Department (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [All Other OP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72] [OP Surgery  (%BC): 72] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 72] [Physical Therapy (%BC): 72] [Respiratory Services/Therapy  (%BC): 72] [Speech Therapy (%BC): 72] [All Other OP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [ED Level 1--99281 ($): 27.09] [ED Level 2--99282 ($): 41.69] [ED Level 3--99283 ($): 73.69] [ED Level 4--99284 ($): 123.51] [ED Level 5--99285 ($): 223.93] [Clinic Visit ($): 59.34] [OP High Cost Drugs (%BC): 40] [Other Outpatient Implant (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Pathology","code_information":[{"code":"5674","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 84] [OP Surgery  (%BC): 84] [Observation (%BC): 84] [Emergency Department (%BC): 84] [Occupational Therapy (%BC): 84] [Physical Therapy (%BC): 84] [Respiratory Services/Therapy  (%BC): 84] [Speech Therapy (%BC): 84] [All Other OP (%BC): 84]","count":"1 through 10","median_amount":7473.74,"10th_percentile":7473.74,"90th_percentile":7473.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41.82] [OP Surgery  (%BC): 41.82] [Observation (%BC): 41.82] [Emergency Department (%BC): 41.82] [Occupational Therapy (%BC): 41.82] [Physical Therapy (%BC): 41.82] [Respiratory Services/Therapy  (%BC): 41.82] [Speech Therapy (%BC): 41.82] [All Other OP (%BC): 41.82]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [All OP services (%BC): 77.4] [OP Surgery  (%BC): 77.4] [Observation (%BC): 77.4] [Emergency Department (%BC): 77.4] [Occupational Therapy (%BC): 77.4] [Physical Therapy (%BC): 77.4] [Respiratory Services/Therapy  (%BC): 77.4] [Speech Therapy (%BC): 77.4] [All Other OP (%BC): 77.4]","count":"1 through 10","median_amount":32051.16,"10th_percentile":32051.16,"90th_percentile":32051.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41] [OP Surgery  (%BC): 41] [Observation (%BC): 41] [Emergency Department (%BC): 41] [Occupational Therapy (%BC): 41] [Physical Therapy (%BC): 41] [Respiratory Services/Therapy  (%BC): 41] [Speech Therapy (%BC): 41] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 60.6] [OP Surgery  (%BC): 60.6] [Observation (%BC): 60.6] [Emergency Department (%BC): 60.6] [Occupational Therapy (%BC): 60.6] [Physical Therapy (%BC): 60.6] [Respiratory Services/Therapy  (%BC): 60.6] [Speech Therapy (%BC): 60.6] [All Other OP (%BC): 60.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Bluecard Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [Emergency Department ($): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 79.2] [OP Surgery  (%BC): 79.2] [Observation (%BC): 79.2] [Emergency Department (%BC): 79.2] [Occupational Therapy (%BC): 79.2] [Physical Therapy (%BC): 79.2] [Respiratory Services/Therapy  (%BC): 79.2] [Speech Therapy (%BC): 79.2] [All Other OP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74] [Observation (%BC): 74] [Emergency Department (%BC): 74] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 74] [Physical Therapy (%BC): 74] [Respiratory Services/Therapy  (%BC): 74] [Speech Therapy (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 78] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 39] [OP Surgery  (%BC): 39] [Observation (%BC): 39] [Emergency Department (%BC): 39] [Occupational Therapy (%BC): 39] [Physical Therapy (%BC): 39] [Respiratory Services/Therapy  (%BC): 39] [Speech Therapy (%BC): 39] [All Other OP (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Mycare Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 75] [OP Surgery  (%BC): 75] [Observation (%BC): 75] [Emergency Department (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [All Other OP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72] [OP Surgery  (%BC): 72] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 72] [Physical Therapy (%BC): 72] [Respiratory Services/Therapy  (%BC): 72] [Speech Therapy (%BC): 72] [All Other OP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [ED Level 1--99281 ($): 27.09] [ED Level 2--99282 ($): 41.69] [ED Level 3--99283 ($): 73.69] [ED Level 4--99284 ($): 123.51] [ED Level 5--99285 ($): 223.93] [Clinic Visit ($): 59.34] [OP High Cost Drugs (%BC): 40] [Other Outpatient Implant (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Drug Administration","code_information":[{"code":"5691","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 84] [OP Surgery  (%BC): 84] [Observation (%BC): 84] [Emergency Department (%BC): 84] [Occupational Therapy (%BC): 84] [Physical Therapy (%BC): 84] [Respiratory Services/Therapy  (%BC): 84] [Speech Therapy (%BC): 84] [All Other OP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41.82] [OP Surgery  (%BC): 41.82] [Observation (%BC): 41.82] [Emergency Department (%BC): 41.82] [Occupational Therapy (%BC): 41.82] [Physical Therapy (%BC): 41.82] [Respiratory Services/Therapy  (%BC): 41.82] [Speech Therapy (%BC): 41.82] [All Other OP (%BC): 41.82]","count":"1 through 10","median_amount":63.65,"10th_percentile":63.65,"90th_percentile":63.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [All OP services (%BC): 77.4] [OP Surgery  (%BC): 77.4] [Observation (%BC): 77.4] [Emergency Department (%BC): 77.4] [Occupational Therapy (%BC): 77.4] [Physical Therapy (%BC): 77.4] [Respiratory Services/Therapy  (%BC): 77.4] [Speech Therapy (%BC): 77.4] [All Other OP (%BC): 77.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"1 through 10","median_amount":4465.67,"10th_percentile":4465.67,"90th_percentile":4465.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41] [OP Surgery  (%BC): 41] [Observation (%BC): 41] [Emergency Department (%BC): 41] [Occupational Therapy (%BC): 41] [Physical Therapy (%BC): 41] [Respiratory Services/Therapy  (%BC): 41] [Speech Therapy (%BC): 41] [All Other OP (%BC): 41]","count":"1 through 10","median_amount":3827.69,"10th_percentile":3827.69,"90th_percentile":3827.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 60.6] [OP Surgery  (%BC): 60.6] [Observation (%BC): 60.6] [Emergency Department (%BC): 60.6] [Occupational Therapy (%BC): 60.6] [Physical Therapy (%BC): 60.6] [Respiratory Services/Therapy  (%BC): 60.6] [Speech Therapy (%BC): 60.6] [All Other OP (%BC): 60.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Bluecard Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [Emergency Department ($): 40]","count":"1 through 10","median_amount":1972.23,"10th_percentile":1972.23,"90th_percentile":1972.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 79.2] [OP Surgery  (%BC): 79.2] [Observation (%BC): 79.2] [Emergency Department (%BC): 79.2] [Occupational Therapy (%BC): 79.2] [Physical Therapy (%BC): 79.2] [Respiratory Services/Therapy  (%BC): 79.2] [Speech Therapy (%BC): 79.2] [All Other OP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74] [Observation (%BC): 74] [Emergency Department (%BC): 74] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 74] [Physical Therapy (%BC): 74] [Respiratory Services/Therapy  (%BC): 74] [Speech Therapy (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 78] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 39] [OP Surgery  (%BC): 39] [Observation (%BC): 39] [Emergency Department (%BC): 39] [Occupational Therapy (%BC): 39] [Physical Therapy (%BC): 39] [Respiratory Services/Therapy  (%BC): 39] [Speech Therapy (%BC): 39] [All Other OP (%BC): 39]","count":"1 through 10","median_amount":3843.31,"10th_percentile":3843.31,"90th_percentile":3843.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":2250.95,"10th_percentile":2250.95,"90th_percentile":2250.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Mycare Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 75] [OP Surgery  (%BC): 75] [Observation (%BC): 75] [Emergency Department (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [All Other OP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72] [OP Surgery  (%BC): 72] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 72] [Physical Therapy (%BC): 72] [Respiratory Services/Therapy  (%BC): 72] [Speech Therapy (%BC): 72] [All Other OP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"1 through 10","median_amount":2596.11,"10th_percentile":2596.11,"90th_percentile":9578.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [ED Level 1--99281 ($): 27.09] [ED Level 2--99282 ($): 41.69] [ED Level 3--99283 ($): 73.69] [ED Level 4--99284 ($): 123.51] [ED Level 5--99285 ($): 223.93] [Clinic Visit ($): 59.34] [OP High Cost Drugs (%BC): 40] [Other Outpatient Implant (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"1 through 10","median_amount":9393.93,"10th_percentile":9393.93,"90th_percentile":9393.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Drug Administration","code_information":[{"code":"5692","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 84] [OP Surgery  (%BC): 84] [Observation (%BC): 84] [Emergency Department (%BC): 84] [Occupational Therapy (%BC): 84] [Physical Therapy (%BC): 84] [Respiratory Services/Therapy  (%BC): 84] [Speech Therapy (%BC): 84] [All Other OP (%BC): 84]","count":"1 through 10","median_amount":7135.3,"10th_percentile":7135.3,"90th_percentile":7135.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":1486.24,"10th_percentile":1486.24,"90th_percentile":1486.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41.82] [OP Surgery  (%BC): 41.82] [Observation (%BC): 41.82] [Emergency Department (%BC): 41.82] [Occupational Therapy (%BC): 41.82] [Physical Therapy (%BC): 41.82] [Respiratory Services/Therapy  (%BC): 41.82] [Speech Therapy (%BC): 41.82] [All Other OP (%BC): 41.82]","count":"131","median_amount":1106.95,"10th_percentile":35.07,"90th_percentile":5706.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [All OP services (%BC): 77.4] [OP Surgery  (%BC): 77.4] [Observation (%BC): 77.4] [Emergency Department (%BC): 77.4] [Occupational Therapy (%BC): 77.4] [Physical Therapy (%BC): 77.4] [Respiratory Services/Therapy  (%BC): 77.4] [Speech Therapy (%BC): 77.4] [All Other OP (%BC): 77.4]","count":"28","median_amount":522.01,"10th_percentile":63.19,"90th_percentile":6463.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"1 through 10","median_amount":1534.69,"10th_percentile":1448.23,"90th_percentile":1629.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41] [OP Surgery  (%BC): 41] [Observation (%BC): 41] [Emergency Department (%BC): 41] [Occupational Therapy (%BC): 41] [Physical Therapy (%BC): 41] [Respiratory Services/Therapy  (%BC): 41] [Speech Therapy (%BC): 41] [All Other OP (%BC): 41]","count":"60","median_amount":152.66,"10th_percentile":34.3,"90th_percentile":1709.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 60.6] [OP Surgery  (%BC): 60.6] [Observation (%BC): 60.6] [Emergency Department (%BC): 60.6] [Occupational Therapy (%BC): 60.6] [Physical Therapy (%BC): 60.6] [Respiratory Services/Therapy  (%BC): 60.6] [Speech Therapy (%BC): 60.6] [All Other OP (%BC): 60.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Bluecard Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"24","median_amount":339.05,"10th_percentile":192.93,"90th_percentile":15566.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [Emergency Department ($): 40]","count":"1 through 10","median_amount":154.25,"10th_percentile":52.83,"90th_percentile":2294.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 79.2] [OP Surgery  (%BC): 79.2] [Observation (%BC): 79.2] [Emergency Department (%BC): 79.2] [Occupational Therapy (%BC): 79.2] [Physical Therapy (%BC): 79.2] [Respiratory Services/Therapy  (%BC): 79.2] [Speech Therapy (%BC): 79.2] [All Other OP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74] [Observation (%BC): 74] [Emergency Department (%BC): 74] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 74] [Physical Therapy (%BC): 74] [Respiratory Services/Therapy  (%BC): 74] [Speech Therapy (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 78] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"1 through 10","median_amount":156.1,"10th_percentile":156.1,"90th_percentile":156.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 39] [OP Surgery  (%BC): 39] [Observation (%BC): 39] [Emergency Department (%BC): 39] [Occupational Therapy (%BC): 39] [Physical Therapy (%BC): 39] [Respiratory Services/Therapy  (%BC): 39] [Speech Therapy (%BC): 39] [All Other OP (%BC): 39]","count":"59","median_amount":311.43,"10th_percentile":67.07,"90th_percentile":1904.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"35","median_amount":822.33,"10th_percentile":68.3,"90th_percentile":1677.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":70.58,"10th_percentile":70.58,"90th_percentile":70.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Mycare Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 75] [OP Surgery  (%BC): 75] [Observation (%BC): 75] [Emergency Department (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [All Other OP (%BC): 75]","count":"40","median_amount":69.36,"10th_percentile":33.45,"90th_percentile":1656.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72] [OP Surgery  (%BC): 72] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 72] [Physical Therapy (%BC): 72] [Respiratory Services/Therapy  (%BC): 72] [Speech Therapy (%BC): 72] [All Other OP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"1 through 10","median_amount":1939.27,"10th_percentile":1939.27,"90th_percentile":1939.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"1 through 10","median_amount":3614.33,"10th_percentile":503.5,"90th_percentile":3934.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [ED Level 1--99281 ($): 27.09] [ED Level 2--99282 ($): 41.69] [ED Level 3--99283 ($): 73.69] [ED Level 4--99284 ($): 123.51] [ED Level 5--99285 ($): 223.93] [Clinic Visit ($): 59.34] [OP High Cost Drugs (%BC): 40] [Other Outpatient Implant (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"26","median_amount":2206.34,"10th_percentile":95.87,"90th_percentile":8699.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"1 through 10","median_amount":113.2,"10th_percentile":113.2,"90th_percentile":113.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Drug Administration","code_information":[{"code":"5693","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 84] [OP Surgery  (%BC): 84] [Observation (%BC): 84] [Emergency Department (%BC): 84] [Occupational Therapy (%BC): 84] [Physical Therapy (%BC): 84] [Respiratory Services/Therapy  (%BC): 84] [Speech Therapy (%BC): 84] [All Other OP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"21","median_amount":178.05,"10th_percentile":178.05,"90th_percentile":280.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41.82] [OP Surgery  (%BC): 41.82] [Observation (%BC): 41.82] [Emergency Department (%BC): 41.82] [Occupational Therapy (%BC): 41.82] [Physical Therapy (%BC): 41.82] [Respiratory Services/Therapy  (%BC): 41.82] [Speech Therapy (%BC): 41.82] [All Other OP (%BC): 41.82]","count":"21","median_amount":436.21,"10th_percentile":185.32,"90th_percentile":1780.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [All OP services (%BC): 77.4] [OP Surgery  (%BC): 77.4] [Observation (%BC): 77.4] [Emergency Department (%BC): 77.4] [Occupational Therapy (%BC): 77.4] [Physical Therapy (%BC): 77.4] [Respiratory Services/Therapy  (%BC): 77.4] [Speech Therapy (%BC): 77.4] [All Other OP (%BC): 77.4]","count":"72","median_amount":981.12,"10th_percentile":432.04,"90th_percentile":4543.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"1 through 10","median_amount":462.36,"10th_percentile":462.36,"90th_percentile":462.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41] [OP Surgery  (%BC): 41] [Observation (%BC): 41] [Emergency Department (%BC): 41] [Occupational Therapy (%BC): 41] [Physical Therapy (%BC): 41] [Respiratory Services/Therapy  (%BC): 41] [Speech Therapy (%BC): 41] [All Other OP (%BC): 41]","count":"29","median_amount":774.85,"10th_percentile":340.76,"90th_percentile":3577.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 60.6] [OP Surgery  (%BC): 60.6] [Observation (%BC): 60.6] [Emergency Department (%BC): 60.6] [Occupational Therapy (%BC): 60.6] [Physical Therapy (%BC): 60.6] [Respiratory Services/Therapy  (%BC): 60.6] [Speech Therapy (%BC): 60.6] [All Other OP (%BC): 60.6]","count":"1 through 10","median_amount":1315.5,"10th_percentile":1315.5,"90th_percentile":1315.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Bluecard Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":346.45,"10th_percentile":254.98,"90th_percentile":346.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [Emergency Department ($): 40]","count":"19","median_amount":432.04,"10th_percentile":417.59,"90th_percentile":1041.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"16","median_amount":432.04,"10th_percentile":417.59,"90th_percentile":432.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 79.2] [OP Surgery  (%BC): 79.2] [Observation (%BC): 79.2] [Emergency Department (%BC): 79.2] [Occupational Therapy (%BC): 79.2] [Physical Therapy (%BC): 79.2] [Respiratory Services/Therapy  (%BC): 79.2] [Speech Therapy (%BC): 79.2] [All Other OP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74] [Observation (%BC): 74] [Emergency Department (%BC): 74] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 74] [Physical Therapy (%BC): 74] [Respiratory Services/Therapy  (%BC): 74] [Speech Therapy (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 78] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"11","median_amount":626.42,"10th_percentile":453.64,"90th_percentile":1025.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 39] [OP Surgery  (%BC): 39] [Observation (%BC): 39] [Emergency Department (%BC): 39] [Occupational Therapy (%BC): 39] [Physical Therapy (%BC): 39] [Respiratory Services/Therapy  (%BC): 39] [Speech Therapy (%BC): 39] [All Other OP (%BC): 39]","count":"29","median_amount":331.8,"10th_percentile":321.61,"90th_percentile":452.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"13","median_amount":1007.86,"10th_percentile":587.49,"90th_percentile":4371.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Mycare Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 75] [OP Surgery  (%BC): 75] [Observation (%BC): 75] [Emergency Department (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [All Other OP (%BC): 75]","count":"34","median_amount":444.67,"10th_percentile":279.78,"90th_percentile":2755.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72] [OP Surgery  (%BC): 72] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 72] [Physical Therapy (%BC): 72] [Respiratory Services/Therapy  (%BC): 72] [Speech Therapy (%BC): 72] [All Other OP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"1 through 10","median_amount":805.6,"10th_percentile":805.6,"90th_percentile":5307.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"1 through 10","median_amount":936.34,"10th_percentile":810.81,"90th_percentile":1821.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [ED Level 1--99281 ($): 27.09] [ED Level 2--99282 ($): 41.69] [ED Level 3--99283 ($): 73.69] [ED Level 4--99284 ($): 123.51] [ED Level 5--99285 ($): 223.93] [Clinic Visit ($): 59.34] [OP High Cost Drugs (%BC): 40] [Other Outpatient Implant (%BC): 40]","count":"1 through 10","median_amount":432.04,"10th_percentile":432.04,"90th_percentile":805.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"31","median_amount":3890.43,"10th_percentile":245.09,"90th_percentile":8843.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Drug Administration","code_information":[{"code":"5694","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 84] [OP Surgery  (%BC): 84] [Observation (%BC): 84] [Emergency Department (%BC): 84] [Occupational Therapy (%BC): 84] [Physical Therapy (%BC): 84] [Respiratory Services/Therapy  (%BC): 84] [Speech Therapy (%BC): 84] [All Other OP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41.82] [OP Surgery  (%BC): 41.82] [Observation (%BC): 41.82] [Emergency Department (%BC): 41.82] [Occupational Therapy (%BC): 41.82] [Physical Therapy (%BC): 41.82] [Respiratory Services/Therapy  (%BC): 41.82] [Speech Therapy (%BC): 41.82] [All Other OP (%BC): 41.82]","count":"38","median_amount":12715.43,"10th_percentile":963.83,"90th_percentile":16433.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [All OP services (%BC): 77.4] [OP Surgery  (%BC): 77.4] [Observation (%BC): 77.4] [Emergency Department (%BC): 77.4] [Occupational Therapy (%BC): 77.4] [Physical Therapy (%BC): 77.4] [Respiratory Services/Therapy  (%BC): 77.4] [Speech Therapy (%BC): 77.4] [All Other OP (%BC): 77.4]","count":"32","median_amount":1087.52,"10th_percentile":631.14,"90th_percentile":10250.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41] [OP Surgery  (%BC): 41] [Observation (%BC): 41] [Emergency Department (%BC): 41] [Occupational Therapy (%BC): 41] [Physical Therapy (%BC): 41] [Respiratory Services/Therapy  (%BC): 41] [Speech Therapy (%BC): 41] [All Other OP (%BC): 41]","count":"22","median_amount":691.87,"10th_percentile":418.23,"90th_percentile":20851.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 60.6] [OP Surgery  (%BC): 60.6] [Observation (%BC): 60.6] [Emergency Department (%BC): 60.6] [Occupational Therapy (%BC): 60.6] [Physical Therapy (%BC): 60.6] [Respiratory Services/Therapy  (%BC): 60.6] [Speech Therapy (%BC): 60.6] [All Other OP (%BC): 60.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Bluecard Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":2346.86,"10th_percentile":2346.86,"90th_percentile":11176.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [Emergency Department ($): 40]","count":"1 through 10","median_amount":8201.6,"10th_percentile":8201.6,"90th_percentile":36428.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 79.2] [OP Surgery  (%BC): 79.2] [Observation (%BC): 79.2] [Emergency Department (%BC): 79.2] [Occupational Therapy (%BC): 79.2] [Physical Therapy (%BC): 79.2] [Respiratory Services/Therapy  (%BC): 79.2] [Speech Therapy (%BC): 79.2] [All Other OP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74] [Observation (%BC): 74] [Emergency Department (%BC): 74] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 74] [Physical Therapy (%BC): 74] [Respiratory Services/Therapy  (%BC): 74] [Speech Therapy (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 78] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 39] [OP Surgery  (%BC): 39] [Observation (%BC): 39] [Emergency Department (%BC): 39] [Occupational Therapy (%BC): 39] [Physical Therapy (%BC): 39] [Respiratory Services/Therapy  (%BC): 39] [Speech Therapy (%BC): 39] [All Other OP (%BC): 39]","count":"1 through 10","median_amount":1786.6,"10th_percentile":1763.14,"90th_percentile":16095.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"49","median_amount":12231.46,"10th_percentile":11018.53,"90th_percentile":25707.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Mycare Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 75] [OP Surgery  (%BC): 75] [Observation (%BC): 75] [Emergency Department (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [All Other OP (%BC): 75]","count":"23","median_amount":3737.13,"10th_percentile":3175.05,"90th_percentile":17113.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72] [OP Surgery  (%BC): 72] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 72] [Physical Therapy (%BC): 72] [Respiratory Services/Therapy  (%BC): 72] [Speech Therapy (%BC): 72] [All Other OP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"1 through 10","median_amount":690.34,"10th_percentile":690.34,"90th_percentile":714.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [ED Level 1--99281 ($): 27.09] [ED Level 2--99282 ($): 41.69] [ED Level 3--99283 ($): 73.69] [ED Level 4--99284 ($): 123.51] [ED Level 5--99285 ($): 223.93] [Clinic Visit ($): 59.34] [OP High Cost Drugs (%BC): 40] [Other Outpatient Implant (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"1 through 10","median_amount":728.58,"10th_percentile":311.97,"90th_percentile":28497.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"1 through 10","median_amount":14299.03,"10th_percentile":10692.6,"90th_percentile":15056.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":417.29,"10th_percentile":200.17,"90th_percentile":506.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 Diagnostic Tests and Related Services","code_information":[{"code":"5721","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 84] [OP Surgery  (%BC): 84] [Observation (%BC): 84] [Emergency Department (%BC): 84] [Occupational Therapy (%BC): 84] [Physical Therapy (%BC): 84] [Respiratory Services/Therapy  (%BC): 84] [Speech Therapy (%BC): 84] [All Other OP (%BC): 84]","count":"1 through 10","median_amount":496.01,"10th_percentile":496.01,"90th_percentile":763.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":272.99,"10th_percentile":272.99,"90th_percentile":272.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41.82] [OP Surgery  (%BC): 41.82] [Observation (%BC): 41.82] [Emergency Department (%BC): 41.82] [Occupational Therapy (%BC): 41.82] [Physical Therapy (%BC): 41.82] [Respiratory Services/Therapy  (%BC): 41.82] [Speech Therapy (%BC): 41.82] [All Other OP (%BC): 41.82]","count":"12","median_amount":282.97,"10th_percentile":237.15,"90th_percentile":490.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [All OP services (%BC): 77.4] [OP Surgery  (%BC): 77.4] [Observation (%BC): 77.4] [Emergency Department (%BC): 77.4] [Occupational Therapy (%BC): 77.4] [Physical Therapy (%BC): 77.4] [Respiratory Services/Therapy  (%BC): 77.4] [Speech Therapy (%BC): 77.4] [All Other OP (%BC): 77.4]","count":"75","median_amount":470.37,"10th_percentile":134.36,"90th_percentile":591.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"1 through 10","median_amount":259.67,"10th_percentile":217.05,"90th_percentile":463.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41] [OP Surgery  (%BC): 41] [Observation (%BC): 41] [Emergency Department (%BC): 41] [Occupational Therapy (%BC): 41] [Physical Therapy (%BC): 41] [Respiratory Services/Therapy  (%BC): 41] [Speech Therapy (%BC): 41] [All Other OP (%BC): 41]","count":"20","median_amount":273.78,"10th_percentile":220.58,"90th_percentile":587.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 60.6] [OP Surgery  (%BC): 60.6] [Observation (%BC): 60.6] [Emergency Department (%BC): 60.6] [Occupational Therapy (%BC): 60.6] [Physical Therapy (%BC): 60.6] [Respiratory Services/Therapy  (%BC): 60.6] [Speech Therapy (%BC): 60.6] [All Other OP (%BC): 60.6]","count":"1 through 10","median_amount":368.43,"10th_percentile":368.43,"90th_percentile":368.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Bluecard Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":220.58,"10th_percentile":220.58,"90th_percentile":220.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [Emergency Department ($): 40]","count":"11","median_amount":184.08,"10th_percentile":134.36,"90th_percentile":202.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":321.03,"10th_percentile":321.03,"90th_percentile":321.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 79.2] [OP Surgery  (%BC): 79.2] [Observation (%BC): 79.2] [Emergency Department (%BC): 79.2] [Occupational Therapy (%BC): 79.2] [Physical Therapy (%BC): 79.2] [Respiratory Services/Therapy  (%BC): 79.2] [Speech Therapy (%BC): 79.2] [All Other OP (%BC): 79.2]","count":"1 through 10","median_amount":449.12,"10th_percentile":449.12,"90th_percentile":449.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74] [Observation (%BC): 74] [Emergency Department (%BC): 74] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 74] [Physical Therapy (%BC): 74] [Respiratory Services/Therapy  (%BC): 74] [Speech Therapy (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 78] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"1 through 10","median_amount":141.08,"10th_percentile":141.08,"90th_percentile":141.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 39] [OP Surgery  (%BC): 39] [Observation (%BC): 39] [Emergency Department (%BC): 39] [Occupational Therapy (%BC): 39] [Physical Therapy (%BC): 39] [Respiratory Services/Therapy  (%BC): 39] [Speech Therapy (%BC): 39] [All Other OP (%BC): 39]","count":"12","median_amount":240.45,"10th_percentile":153.54,"90th_percentile":351.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"27","median_amount":438.18,"10th_percentile":280.23,"90th_percentile":578.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":133.76,"10th_percentile":133.76,"90th_percentile":133.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Mycare Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 75] [OP Surgery  (%BC): 75] [Observation (%BC): 75] [Emergency Department (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [All Other OP (%BC): 75]","count":"1 through 10","median_amount":330.73,"10th_percentile":216.17,"90th_percentile":720.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72] [OP Surgery  (%BC): 72] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 72] [Physical Therapy (%BC): 72] [Respiratory Services/Therapy  (%BC): 72] [Speech Therapy (%BC): 72] [All Other OP (%BC): 72]","count":"1 through 10","median_amount":408.29,"10th_percentile":408.29,"90th_percentile":408.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"1 through 10","median_amount":514.49,"10th_percentile":489.38,"90th_percentile":514.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"1 through 10","median_amount":220.58,"10th_percentile":220.58,"90th_percentile":220.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [ED Level 1--99281 ($): 27.09] [ED Level 2--99282 ($): 41.69] [ED Level 3--99283 ($): 73.69] [ED Level 4--99284 ($): 123.51] [ED Level 5--99285 ($): 223.93] [Clinic Visit ($): 59.34] [OP High Cost Drugs (%BC): 40] [Other Outpatient Implant (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"1 through 10","median_amount":376.49,"10th_percentile":292.42,"90th_percentile":808.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"1 through 10","median_amount":950.33,"10th_percentile":950.33,"90th_percentile":950.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Diagnostic Tests and Related Services","code_information":[{"code":"5722","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 84] [OP Surgery  (%BC): 84] [Observation (%BC): 84] [Emergency Department (%BC): 84] [Occupational Therapy (%BC): 84] [Physical Therapy (%BC): 84] [Respiratory Services/Therapy  (%BC): 84] [Speech Therapy (%BC): 84] [All Other OP (%BC): 84]","count":"1 through 10","median_amount":1199.03,"10th_percentile":692.17,"90th_percentile":2456.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":222.28,"10th_percentile":222.28,"90th_percentile":222.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41.82] [OP Surgery  (%BC): 41.82] [Observation (%BC): 41.82] [Emergency Department (%BC): 41.82] [Occupational Therapy (%BC): 41.82] [Physical Therapy (%BC): 41.82] [Respiratory Services/Therapy  (%BC): 41.82] [Speech Therapy (%BC): 41.82] [All Other OP (%BC): 41.82]","count":"28","median_amount":277.35,"10th_percentile":219.16,"90th_percentile":703.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [All OP services (%BC): 77.4] [OP Surgery  (%BC): 77.4] [Observation (%BC): 77.4] [Emergency Department (%BC): 77.4] [Occupational Therapy (%BC): 77.4] [Physical Therapy (%BC): 77.4] [Respiratory Services/Therapy  (%BC): 77.4] [Speech Therapy (%BC): 77.4] [All Other OP (%BC): 77.4]","count":"58","median_amount":579.83,"10th_percentile":328.39,"90th_percentile":1137.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"1 through 10","median_amount":524.68,"10th_percentile":211.42,"90th_percentile":603.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41] [OP Surgery  (%BC): 41] [Observation (%BC): 41] [Emergency Department (%BC): 41] [Occupational Therapy (%BC): 41] [Physical Therapy (%BC): 41] [Respiratory Services/Therapy  (%BC): 41] [Speech Therapy (%BC): 41] [All Other OP (%BC): 41]","count":"17","median_amount":319.04,"10th_percentile":223.27,"90th_percentile":717.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 60.6] [OP Surgery  (%BC): 60.6] [Observation (%BC): 60.6] [Emergency Department (%BC): 60.6] [Occupational Therapy (%BC): 60.6] [Physical Therapy (%BC): 60.6] [Respiratory Services/Therapy  (%BC): 60.6] [Speech Therapy (%BC): 60.6] [All Other OP (%BC): 60.6]","count":"1 through 10","median_amount":890.62,"10th_percentile":890.62,"90th_percentile":890.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Bluecard Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":1111.87,"10th_percentile":1111.87,"90th_percentile":1111.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [Emergency Department ($): 40]","count":"12","median_amount":328.39,"10th_percentile":317.41,"90th_percentile":328.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":339.16,"10th_percentile":328.39,"90th_percentile":388.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 79.2] [OP Surgery  (%BC): 79.2] [Observation (%BC): 79.2] [Emergency Department (%BC): 79.2] [Occupational Therapy (%BC): 79.2] [Physical Therapy (%BC): 79.2] [Respiratory Services/Therapy  (%BC): 79.2] [Speech Therapy (%BC): 79.2] [All Other OP (%BC): 79.2]","count":"1 through 10","median_amount":483.52,"10th_percentile":483.52,"90th_percentile":483.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74] [Observation (%BC): 74] [Emergency Department (%BC): 74] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 74] [Physical Therapy (%BC): 74] [Respiratory Services/Therapy  (%BC): 74] [Speech Therapy (%BC): 74] [All Other OP (%BC): 74]","count":"1 through 10","median_amount":1066.44,"10th_percentile":1066.44,"90th_percentile":1066.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 78] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"1 through 10","median_amount":368.44,"10th_percentile":344.81,"90th_percentile":988.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 39] [OP Surgery  (%BC): 39] [Observation (%BC): 39] [Emergency Department (%BC): 39] [Occupational Therapy (%BC): 39] [Physical Therapy (%BC): 39] [Respiratory Services/Therapy  (%BC): 39] [Speech Therapy (%BC): 39] [All Other OP (%BC): 39]","count":"16","median_amount":363.26,"10th_percentile":77.25,"90th_percentile":618.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"18","median_amount":567.53,"10th_percentile":235.78,"90th_percentile":2091.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":349.34,"10th_percentile":349.34,"90th_percentile":349.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Mycare Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 75] [OP Surgery  (%BC): 75] [Observation (%BC): 75] [Emergency Department (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [All Other OP (%BC): 75]","count":"20","median_amount":519.14,"10th_percentile":220.16,"90th_percentile":1075.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72] [OP Surgery  (%BC): 72] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 72] [Physical Therapy (%BC): 72] [Respiratory Services/Therapy  (%BC): 72] [Speech Therapy (%BC): 72] [All Other OP (%BC): 72]","count":"1 through 10","median_amount":1037.61,"10th_percentile":1037.61,"90th_percentile":1037.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"1 through 10","median_amount":1243.69,"10th_percentile":526.86,"90th_percentile":1441.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"1 through 10","median_amount":1247.9,"10th_percentile":562.05,"90th_percentile":3829.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [ED Level 1--99281 ($): 27.09] [ED Level 2--99282 ($): 41.69] [ED Level 3--99283 ($): 73.69] [ED Level 4--99284 ($): 123.51] [ED Level 5--99285 ($): 223.93] [Clinic Visit ($): 59.34] [OP High Cost Drugs (%BC): 40] [Other Outpatient Implant (%BC): 40]","count":"1 through 10","median_amount":328.39,"10th_percentile":328.39,"90th_percentile":350.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"19","median_amount":511.02,"10th_percentile":238.1,"90th_percentile":1268.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"1 through 10","median_amount":252.64,"10th_percentile":252.64,"90th_percentile":252.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Diagnostic Tests and Related Services","code_information":[{"code":"5723","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 84] [OP Surgery  (%BC): 84] [Observation (%BC): 84] [Emergency Department (%BC): 84] [Occupational Therapy (%BC): 84] [Physical Therapy (%BC): 84] [Respiratory Services/Therapy  (%BC): 84] [Speech Therapy (%BC): 84] [All Other OP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41.82] [OP Surgery  (%BC): 41.82] [Observation (%BC): 41.82] [Emergency Department (%BC): 41.82] [Occupational Therapy (%BC): 41.82] [Physical Therapy (%BC): 41.82] [Respiratory Services/Therapy  (%BC): 41.82] [Speech Therapy (%BC): 41.82] [All Other OP (%BC): 41.82]","count":"1 through 10","median_amount":16.37,"10th_percentile":16.37,"90th_percentile":16.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [All OP services (%BC): 77.4] [OP Surgery  (%BC): 77.4] [Observation (%BC): 77.4] [Emergency Department (%BC): 77.4] [Occupational Therapy (%BC): 77.4] [Physical Therapy (%BC): 77.4] [Respiratory Services/Therapy  (%BC): 77.4] [Speech Therapy (%BC): 77.4] [All Other OP (%BC): 77.4]","count":"1 through 10","median_amount":1096.71,"10th_percentile":1096.71,"90th_percentile":1096.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41] [OP Surgery  (%BC): 41] [Observation (%BC): 41] [Emergency Department (%BC): 41] [Occupational Therapy (%BC): 41] [Physical Therapy (%BC): 41] [Respiratory Services/Therapy  (%BC): 41] [Speech Therapy (%BC): 41] [All Other OP (%BC): 41]","count":"1 through 10","median_amount":15.21,"10th_percentile":15.21,"90th_percentile":15.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 60.6] [OP Surgery  (%BC): 60.6] [Observation (%BC): 60.6] [Emergency Department (%BC): 60.6] [Occupational Therapy (%BC): 60.6] [Physical Therapy (%BC): 60.6] [Respiratory Services/Therapy  (%BC): 60.6] [Speech Therapy (%BC): 60.6] [All Other OP (%BC): 60.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Bluecard Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [Emergency Department ($): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 79.2] [OP Surgery  (%BC): 79.2] [Observation (%BC): 79.2] [Emergency Department (%BC): 79.2] [Occupational Therapy (%BC): 79.2] [Physical Therapy (%BC): 79.2] [Respiratory Services/Therapy  (%BC): 79.2] [Speech Therapy (%BC): 79.2] [All Other OP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74] [Observation (%BC): 74] [Emergency Department (%BC): 74] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 74] [Physical Therapy (%BC): 74] [Respiratory Services/Therapy  (%BC): 74] [Speech Therapy (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 78] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 39] [OP Surgery  (%BC): 39] [Observation (%BC): 39] [Emergency Department (%BC): 39] [Occupational Therapy (%BC): 39] [Physical Therapy (%BC): 39] [Respiratory Services/Therapy  (%BC): 39] [Speech Therapy (%BC): 39] [All Other OP (%BC): 39]","count":"1 through 10","median_amount":16.04,"10th_percentile":16.04,"90th_percentile":16.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":41.13,"10th_percentile":41.13,"90th_percentile":41.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Mycare Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 75] [OP Surgery  (%BC): 75] [Observation (%BC): 75] [Emergency Department (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [All Other OP (%BC): 75]","count":"1 through 10","median_amount":787.49,"10th_percentile":787.49,"90th_percentile":787.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72] [OP Surgery  (%BC): 72] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 72] [Physical Therapy (%BC): 72] [Respiratory Services/Therapy  (%BC): 72] [Speech Therapy (%BC): 72] [All Other OP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"1 through 10","median_amount":15.21,"10th_percentile":15.21,"90th_percentile":15.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [ED Level 1--99281 ($): 27.09] [ED Level 2--99282 ($): 41.69] [ED Level 3--99283 ($): 73.69] [ED Level 4--99284 ($): 123.51] [ED Level 5--99285 ($): 223.93] [Clinic Visit ($): 59.34] [OP High Cost Drugs (%BC): 40] [Other Outpatient Implant (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"1 through 10","median_amount":16.04,"10th_percentile":16.04,"90th_percentile":16.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":16.04,"10th_percentile":16.04,"90th_percentile":16.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 4 Diagnostic Tests and Related Services","code_information":[{"code":"5724","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 84] [OP Surgery  (%BC): 84] [Observation (%BC): 84] [Emergency Department (%BC): 84] [Occupational Therapy (%BC): 84] [Physical Therapy (%BC): 84] [Respiratory Services/Therapy  (%BC): 84] [Speech Therapy (%BC): 84] [All Other OP (%BC): 84]","count":"1 through 10","median_amount":4170.78,"10th_percentile":3849.32,"90th_percentile":5291.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":1825.12,"10th_percentile":1825.12,"90th_percentile":1825.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41.82] [OP Surgery  (%BC): 41.82] [Observation (%BC): 41.82] [Emergency Department (%BC): 41.82] [Occupational Therapy (%BC): 41.82] [Physical Therapy (%BC): 41.82] [Respiratory Services/Therapy  (%BC): 41.82] [Speech Therapy (%BC): 41.82] [All Other OP (%BC): 41.82]","count":"36","median_amount":1891.89,"10th_percentile":1660.87,"90th_percentile":1994.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [All OP services (%BC): 77.4] [OP Surgery  (%BC): 77.4] [Observation (%BC): 77.4] [Emergency Department (%BC): 77.4] [Occupational Therapy (%BC): 77.4] [Physical Therapy (%BC): 77.4] [Respiratory Services/Therapy  (%BC): 77.4] [Speech Therapy (%BC): 77.4] [All Other OP (%BC): 77.4]","count":"68","median_amount":3809.9,"10th_percentile":1096.71,"90th_percentile":3955.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"1 through 10","median_amount":1825.12,"10th_percentile":1684.45,"90th_percentile":1828.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41] [OP Surgery  (%BC): 41] [Observation (%BC): 41] [Emergency Department (%BC): 41] [Occupational Therapy (%BC): 41] [Physical Therapy (%BC): 41] [Respiratory Services/Therapy  (%BC): 41] [Speech Therapy (%BC): 41] [All Other OP (%BC): 41]","count":"27","median_amount":1732.9,"10th_percentile":1602.26,"90th_percentile":1913.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 60.6] [OP Surgery  (%BC): 60.6] [Observation (%BC): 60.6] [Emergency Department (%BC): 60.6] [Occupational Therapy (%BC): 60.6] [Physical Therapy (%BC): 60.6] [Respiratory Services/Therapy  (%BC): 60.6] [Speech Therapy (%BC): 60.6] [All Other OP (%BC): 60.6]","count":"1 through 10","median_amount":3098.01,"10th_percentile":3098.01,"90th_percentile":3098.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Bluecard Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":1854.8,"10th_percentile":1854.8,"90th_percentile":1854.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [Emergency Department ($): 40]","count":"14","median_amount":1096.71,"10th_percentile":1096.71,"90th_percentile":1096.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":1096.71,"10th_percentile":1096.71,"90th_percentile":2193.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 79.2] [OP Surgery  (%BC): 79.2] [Observation (%BC): 79.2] [Emergency Department (%BC): 79.2] [Occupational Therapy (%BC): 79.2] [Physical Therapy (%BC): 79.2] [Respiratory Services/Therapy  (%BC): 79.2] [Speech Therapy (%BC): 79.2] [All Other OP (%BC): 79.2]","count":"1 through 10","median_amount":3664.26,"10th_percentile":3664.26,"90th_percentile":3664.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74] [Observation (%BC): 74] [Emergency Department (%BC): 74] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 74] [Physical Therapy (%BC): 74] [Respiratory Services/Therapy  (%BC): 74] [Speech Therapy (%BC): 74] [All Other OP (%BC): 74]","count":"1 through 10","median_amount":3528.57,"10th_percentile":3423.68,"90th_percentile":3709.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 78] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"1 through 10","median_amount":1151.55,"10th_percentile":1151.55,"90th_percentile":1151.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 39] [OP Surgery  (%BC): 39] [Observation (%BC): 39] [Emergency Department (%BC): 39] [Occupational Therapy (%BC): 39] [Physical Therapy (%BC): 39] [Respiratory Services/Therapy  (%BC): 39] [Speech Therapy (%BC): 39] [All Other OP (%BC): 39]","count":"21","median_amount":1688.2,"10th_percentile":469.61,"90th_percentile":1918.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"49","median_amount":3400.54,"10th_percentile":1872.43,"90th_percentile":3684.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Mycare Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 75] [OP Surgery  (%BC): 75] [Observation (%BC): 75] [Emergency Department (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [All Other OP (%BC): 75]","count":"33","median_amount":1818.1,"10th_percentile":1716.58,"90th_percentile":3741.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72] [OP Surgery  (%BC): 72] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 72] [Physical Therapy (%BC): 72] [Respiratory Services/Therapy  (%BC): 72] [Speech Therapy (%BC): 72] [All Other OP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"1 through 10","median_amount":4326.18,"10th_percentile":4115.08,"90th_percentile":4326.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"1 through 10","median_amount":4006.26,"10th_percentile":1955.05,"90th_percentile":4342.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [ED Level 1--99281 ($): 27.09] [ED Level 2--99282 ($): 41.69] [ED Level 3--99283 ($): 73.69] [ED Level 4--99284 ($): 123.51] [ED Level 5--99285 ($): 223.93] [Clinic Visit ($): 59.34] [OP High Cost Drugs (%BC): 40] [Other Outpatient Implant (%BC): 40]","count":"1 through 10","median_amount":1096.71,"10th_percentile":1096.71,"90th_percentile":1096.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"20","median_amount":1955.05,"10th_percentile":1804.37,"90th_percentile":4411.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"1 through 10","median_amount":1818.2,"10th_percentile":1818.2,"90th_percentile":1818.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Minor Procedures","code_information":[{"code":"5731","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 84] [OP Surgery  (%BC): 84] [Observation (%BC): 84] [Emergency Department (%BC): 84] [Occupational Therapy (%BC): 84] [Physical Therapy (%BC): 84] [Respiratory Services/Therapy  (%BC): 84] [Speech Therapy (%BC): 84] [All Other OP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41.82] [OP Surgery  (%BC): 41.82] [Observation (%BC): 41.82] [Emergency Department (%BC): 41.82] [Occupational Therapy (%BC): 41.82] [Physical Therapy (%BC): 41.82] [Respiratory Services/Therapy  (%BC): 41.82] [Speech Therapy (%BC): 41.82] [All Other OP (%BC): 41.82]","count":"1 through 10","median_amount":16383.78,"10th_percentile":16383.78,"90th_percentile":16383.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [All OP services (%BC): 77.4] [OP Surgery  (%BC): 77.4] [Observation (%BC): 77.4] [Emergency Department (%BC): 77.4] [Occupational Therapy (%BC): 77.4] [Physical Therapy (%BC): 77.4] [Respiratory Services/Therapy  (%BC): 77.4] [Speech Therapy (%BC): 77.4] [All Other OP (%BC): 77.4]","count":"1 through 10","median_amount":417.37,"10th_percentile":417.37,"90th_percentile":53014.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"1 through 10","median_amount":192.5,"10th_percentile":192.5,"90th_percentile":192.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41] [OP Surgery  (%BC): 41] [Observation (%BC): 41] [Emergency Department (%BC): 41] [Occupational Therapy (%BC): 41] [Physical Therapy (%BC): 41] [Respiratory Services/Therapy  (%BC): 41] [Speech Therapy (%BC): 41] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 60.6] [OP Surgery  (%BC): 60.6] [Observation (%BC): 60.6] [Emergency Department (%BC): 60.6] [Occupational Therapy (%BC): 60.6] [Physical Therapy (%BC): 60.6] [Respiratory Services/Therapy  (%BC): 60.6] [Speech Therapy (%BC): 60.6] [All Other OP (%BC): 60.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Bluecard Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [Emergency Department ($): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":82.93,"10th_percentile":82.93,"90th_percentile":82.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 79.2] [OP Surgery  (%BC): 79.2] [Observation (%BC): 79.2] [Emergency Department (%BC): 79.2] [Occupational Therapy (%BC): 79.2] [Physical Therapy (%BC): 79.2] [Respiratory Services/Therapy  (%BC): 79.2] [Speech Therapy (%BC): 79.2] [All Other OP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74] [Observation (%BC): 74] [Emergency Department (%BC): 74] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 74] [Physical Therapy (%BC): 74] [Respiratory Services/Therapy  (%BC): 74] [Speech Therapy (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 78] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 39] [OP Surgery  (%BC): 39] [Observation (%BC): 39] [Emergency Department (%BC): 39] [Occupational Therapy (%BC): 39] [Physical Therapy (%BC): 39] [Respiratory Services/Therapy  (%BC): 39] [Speech Therapy (%BC): 39] [All Other OP (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Mycare Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 75] [OP Surgery  (%BC): 75] [Observation (%BC): 75] [Emergency Department (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [All Other OP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72] [OP Surgery  (%BC): 72] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 72] [Physical Therapy (%BC): 72] [Respiratory Services/Therapy  (%BC): 72] [Speech Therapy (%BC): 72] [All Other OP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [ED Level 1--99281 ($): 27.09] [ED Level 2--99282 ($): 41.69] [ED Level 3--99283 ($): 73.69] [ED Level 4--99284 ($): 123.51] [ED Level 5--99285 ($): 223.93] [Clinic Visit ($): 59.34] [OP High Cost Drugs (%BC): 40] [Other Outpatient Implant (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Minor Procedures","code_information":[{"code":"5732","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 84] [OP Surgery  (%BC): 84] [Observation (%BC): 84] [Emergency Department (%BC): 84] [Occupational Therapy (%BC): 84] [Physical Therapy (%BC): 84] [Respiratory Services/Therapy  (%BC): 84] [Speech Therapy (%BC): 84] [All Other OP (%BC): 84]","count":"1 through 10","median_amount":60.86,"10th_percentile":60.86,"90th_percentile":60.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41.82] [OP Surgery  (%BC): 41.82] [Observation (%BC): 41.82] [Emergency Department (%BC): 41.82] [Occupational Therapy (%BC): 41.82] [Physical Therapy (%BC): 41.82] [Respiratory Services/Therapy  (%BC): 41.82] [Speech Therapy (%BC): 41.82] [All Other OP (%BC): 41.82]","count":"1 through 10","median_amount":27.61,"10th_percentile":26.26,"90th_percentile":29.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [All OP services (%BC): 77.4] [OP Surgery  (%BC): 77.4] [Observation (%BC): 77.4] [Emergency Department (%BC): 77.4] [Occupational Therapy (%BC): 77.4] [Physical Therapy (%BC): 77.4] [Respiratory Services/Therapy  (%BC): 77.4] [Speech Therapy (%BC): 77.4] [All Other OP (%BC): 77.4]","count":"15","median_amount":57.72,"10th_percentile":55.59,"90th_percentile":324.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"1 through 10","median_amount":26.64,"10th_percentile":26.64,"90th_percentile":26.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41] [OP Surgery  (%BC): 41] [Observation (%BC): 41] [Emergency Department (%BC): 41] [Occupational Therapy (%BC): 41] [Physical Therapy (%BC): 41] [Respiratory Services/Therapy  (%BC): 41] [Speech Therapy (%BC): 41] [All Other OP (%BC): 41]","count":"1 through 10","median_amount":59.71,"10th_percentile":27.07,"90th_percentile":120.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 60.6] [OP Surgery  (%BC): 60.6] [Observation (%BC): 60.6] [Emergency Department (%BC): 60.6] [Occupational Therapy (%BC): 60.6] [Physical Therapy (%BC): 60.6] [Respiratory Services/Therapy  (%BC): 60.6] [Speech Therapy (%BC): 60.6] [All Other OP (%BC): 60.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Bluecard Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [Emergency Department ($): 40]","count":"11","median_amount":73.15,"10th_percentile":73.15,"90th_percentile":130.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 79.2] [OP Surgery  (%BC): 79.2] [Observation (%BC): 79.2] [Emergency Department (%BC): 79.2] [Occupational Therapy (%BC): 79.2] [Physical Therapy (%BC): 79.2] [Respiratory Services/Therapy  (%BC): 79.2] [Speech Therapy (%BC): 79.2] [All Other OP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74] [Observation (%BC): 74] [Emergency Department (%BC): 74] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 74] [Physical Therapy (%BC): 74] [Respiratory Services/Therapy  (%BC): 74] [Speech Therapy (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 78] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"1 through 10","median_amount":159.3,"10th_percentile":159.3,"90th_percentile":159.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 39] [OP Surgery  (%BC): 39] [Observation (%BC): 39] [Emergency Department (%BC): 39] [Occupational Therapy (%BC): 39] [Physical Therapy (%BC): 39] [Respiratory Services/Therapy  (%BC): 39] [Speech Therapy (%BC): 39] [All Other OP (%BC): 39]","count":"1 through 10","median_amount":59.71,"10th_percentile":59.71,"90th_percentile":135.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"11","median_amount":53.77,"10th_percentile":53.77,"90th_percentile":53.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Mycare Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 75] [OP Surgery  (%BC): 75] [Observation (%BC): 75] [Emergency Department (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [All Other OP (%BC): 75]","count":"1 through 10","median_amount":54.6,"10th_percentile":26.72,"90th_percentile":120.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72] [OP Surgery  (%BC): 72] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 72] [Physical Therapy (%BC): 72] [Respiratory Services/Therapy  (%BC): 72] [Speech Therapy (%BC): 72] [All Other OP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"1 through 10","median_amount":60.05,"10th_percentile":60.05,"90th_percentile":60.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"1 through 10","median_amount":27.07,"10th_percentile":27.07,"90th_percentile":27.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [ED Level 1--99281 ($): 27.09] [ED Level 2--99282 ($): 41.69] [ED Level 3--99283 ($): 73.69] [ED Level 4--99284 ($): 123.51] [ED Level 5--99285 ($): 223.93] [Clinic Visit ($): 59.34] [OP High Cost Drugs (%BC): 40] [Other Outpatient Implant (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"1 through 10","median_amount":64.37,"10th_percentile":64.37,"90th_percentile":64.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"1 through 10","median_amount":25.15,"10th_percentile":25.15,"90th_percentile":25.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Minor Procedures","code_information":[{"code":"5733","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 84] [OP Surgery  (%BC): 84] [Observation (%BC): 84] [Emergency Department (%BC): 84] [Occupational Therapy (%BC): 84] [Physical Therapy (%BC): 84] [Respiratory Services/Therapy  (%BC): 84] [Speech Therapy (%BC): 84] [All Other OP (%BC): 84]","count":"14","median_amount":353.87,"10th_percentile":170.27,"90th_percentile":438.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":74.51,"10th_percentile":6.87,"90th_percentile":160.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41.82] [OP Surgery  (%BC): 41.82] [Observation (%BC): 41.82] [Emergency Department (%BC): 41.82] [Occupational Therapy (%BC): 41.82] [Physical Therapy (%BC): 41.82] [Respiratory Services/Therapy  (%BC): 41.82] [Speech Therapy (%BC): 41.82] [All Other OP (%BC): 41.82]","count":"51","median_amount":157.72,"10th_percentile":77.23,"90th_percentile":205.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [All OP services (%BC): 77.4] [OP Surgery  (%BC): 77.4] [Observation (%BC): 77.4] [Emergency Department (%BC): 77.4] [Occupational Therapy (%BC): 77.4] [Physical Therapy (%BC): 77.4] [Respiratory Services/Therapy  (%BC): 77.4] [Speech Therapy (%BC): 77.4] [All Other OP (%BC): 77.4]","count":"104","median_amount":335.58,"10th_percentile":114.69,"90th_percentile":493.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"18","median_amount":98.4,"10th_percentile":58.44,"90th_percentile":176.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41] [OP Surgery  (%BC): 41] [Observation (%BC): 41] [Emergency Department (%BC): 41] [Occupational Therapy (%BC): 41] [Physical Therapy (%BC): 41] [Respiratory Services/Therapy  (%BC): 41] [Speech Therapy (%BC): 41] [All Other OP (%BC): 41]","count":"31","median_amount":152.97,"10th_percentile":6.84,"90th_percentile":173.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 60.6] [OP Surgery  (%BC): 60.6] [Observation (%BC): 60.6] [Emergency Department (%BC): 60.6] [Occupational Therapy (%BC): 60.6] [Physical Therapy (%BC): 60.6] [Respiratory Services/Therapy  (%BC): 60.6] [Speech Therapy (%BC): 60.6] [All Other OP (%BC): 60.6]","count":"1 through 10","median_amount":126.47,"10th_percentile":126.47,"90th_percentile":262.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Bluecard Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":75.72,"10th_percentile":75.72,"90th_percentile":214.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [Emergency Department ($): 40]","count":"21","median_amount":77.74,"10th_percentile":36.6,"90th_percentile":80.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":35.37,"10th_percentile":18.86,"90th_percentile":80.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 79.2] [OP Surgery  (%BC): 79.2] [Observation (%BC): 79.2] [Emergency Department (%BC): 79.2] [Occupational Therapy (%BC): 79.2] [Physical Therapy (%BC): 79.2] [Respiratory Services/Therapy  (%BC): 79.2] [Speech Therapy (%BC): 79.2] [All Other OP (%BC): 79.2]","count":"1 through 10","median_amount":162.08,"10th_percentile":162.08,"90th_percentile":336.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74] [Observation (%BC): 74] [Emergency Department (%BC): 74] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 74] [Physical Therapy (%BC): 74] [Respiratory Services/Therapy  (%BC): 74] [Speech Therapy (%BC): 74] [All Other OP (%BC): 74]","count":"1 through 10","median_amount":309.27,"10th_percentile":309.27,"90th_percentile":502.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 78] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"1 through 10","median_amount":84.46,"10th_percentile":84.46,"90th_percentile":155.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 39] [OP Surgery  (%BC): 39] [Observation (%BC): 39] [Emergency Department (%BC): 39] [Occupational Therapy (%BC): 39] [Physical Therapy (%BC): 39] [Respiratory Services/Therapy  (%BC): 39] [Speech Therapy (%BC): 39] [All Other OP (%BC): 39]","count":"28","median_amount":79.81,"10th_percentile":7.21,"90th_percentile":260.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"49","median_amount":227.5,"10th_percentile":150.42,"90th_percentile":492.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":82.86,"10th_percentile":82.86,"90th_percentile":82.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Mycare Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"1 through 10","median_amount":173.95,"10th_percentile":173.95,"90th_percentile":173.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 75] [OP Surgery  (%BC): 75] [Observation (%BC): 75] [Emergency Department (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [All Other OP (%BC): 75]","count":"32","median_amount":153.48,"10th_percentile":74.61,"90th_percentile":323.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72] [OP Surgery  (%BC): 72] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 72] [Physical Therapy (%BC): 72] [Respiratory Services/Therapy  (%BC): 72] [Speech Therapy (%BC): 72] [All Other OP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"1 through 10","median_amount":79.03,"10th_percentile":79.03,"90th_percentile":79.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"15","median_amount":372.63,"10th_percentile":176.61,"90th_percentile":386.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"1 through 10","median_amount":250.27,"10th_percentile":250.27,"90th_percentile":861.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [ED Level 1--99281 ($): 27.09] [ED Level 2--99282 ($): 41.69] [ED Level 3--99283 ($): 73.69] [ED Level 4--99284 ($): 123.51] [ED Level 5--99285 ($): 223.93] [Clinic Visit ($): 59.34] [OP High Cost Drugs (%BC): 40] [Other Outpatient Implant (%BC): 40]","count":"1 through 10","median_amount":80.44,"10th_percentile":35.37,"90th_percentile":108.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"31","median_amount":165.87,"10th_percentile":62.6,"90th_percentile":493.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"1 through 10","median_amount":73.96,"10th_percentile":73.96,"90th_percentile":73.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"11","median_amount":99.49,"10th_percentile":59.57,"90th_percentile":165.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 4 Minor Procedures","code_information":[{"code":"5734","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 84] [OP Surgery  (%BC): 84] [Observation (%BC): 84] [Emergency Department (%BC): 84] [Occupational Therapy (%BC): 84] [Physical Therapy (%BC): 84] [Respiratory Services/Therapy  (%BC): 84] [Speech Therapy (%BC): 84] [All Other OP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41.82] [OP Surgery  (%BC): 41.82] [Observation (%BC): 41.82] [Emergency Department (%BC): 41.82] [Occupational Therapy (%BC): 41.82] [Physical Therapy (%BC): 41.82] [Respiratory Services/Therapy  (%BC): 41.82] [Speech Therapy (%BC): 41.82] [All Other OP (%BC): 41.82]","count":"12","median_amount":198.58,"10th_percentile":138.25,"90th_percentile":217.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [All OP services (%BC): 77.4] [OP Surgery  (%BC): 77.4] [Observation (%BC): 77.4] [Emergency Department (%BC): 77.4] [Occupational Therapy (%BC): 77.4] [Physical Therapy (%BC): 77.4] [Respiratory Services/Therapy  (%BC): 77.4] [Speech Therapy (%BC): 77.4] [All Other OP (%BC): 77.4]","count":"20","median_amount":453.26,"10th_percentile":292.68,"90th_percentile":596.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"1 through 10","median_amount":146.09,"10th_percentile":146.09,"90th_percentile":146.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41] [OP Surgery  (%BC): 41] [Observation (%BC): 41] [Emergency Department (%BC): 41] [Occupational Therapy (%BC): 41] [Physical Therapy (%BC): 41] [Respiratory Services/Therapy  (%BC): 41] [Speech Therapy (%BC): 41] [All Other OP (%BC): 41]","count":"1 through 10","median_amount":197.71,"10th_percentile":169.75,"90th_percentile":207.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 60.6] [OP Surgery  (%BC): 60.6] [Observation (%BC): 60.6] [Emergency Department (%BC): 60.6] [Occupational Therapy (%BC): 60.6] [Physical Therapy (%BC): 60.6] [Respiratory Services/Therapy  (%BC): 60.6] [Speech Therapy (%BC): 60.6] [All Other OP (%BC): 60.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Bluecard Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":212.1,"10th_percentile":212.1,"90th_percentile":212.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [Emergency Department ($): 40]","count":"1 through 10","median_amount":833.6,"10th_percentile":290.01,"90th_percentile":949.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 79.2] [OP Surgery  (%BC): 79.2] [Observation (%BC): 79.2] [Emergency Department (%BC): 79.2] [Occupational Therapy (%BC): 79.2] [Physical Therapy (%BC): 79.2] [Respiratory Services/Therapy  (%BC): 79.2] [Speech Therapy (%BC): 79.2] [All Other OP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74] [Observation (%BC): 74] [Emergency Department (%BC): 74] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 74] [Physical Therapy (%BC): 74] [Respiratory Services/Therapy  (%BC): 74] [Speech Therapy (%BC): 74] [All Other OP (%BC): 74]","count":"1 through 10","median_amount":424.2,"10th_percentile":424.2,"90th_percentile":424.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 78] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 39] [OP Surgery  (%BC): 39] [Observation (%BC): 39] [Emergency Department (%BC): 39] [Occupational Therapy (%BC): 39] [Physical Therapy (%BC): 39] [Respiratory Services/Therapy  (%BC): 39] [Speech Therapy (%BC): 39] [All Other OP (%BC): 39]","count":"1 through 10","median_amount":232.13,"10th_percentile":197.71,"90th_percentile":232.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"1 through 10","median_amount":421.33,"10th_percentile":269.24,"90th_percentile":2139.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Mycare Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 75] [OP Surgery  (%BC): 75] [Observation (%BC): 75] [Emergency Department (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [All Other OP (%BC): 75]","count":"1 through 10","median_amount":427.87,"10th_percentile":427.87,"90th_percentile":427.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72] [OP Surgery  (%BC): 72] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 72] [Physical Therapy (%BC): 72] [Respiratory Services/Therapy  (%BC): 72] [Speech Therapy (%BC): 72] [All Other OP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"1 through 10","median_amount":426.29,"10th_percentile":426.29,"90th_percentile":426.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [ED Level 1--99281 ($): 27.09] [ED Level 2--99282 ($): 41.69] [ED Level 3--99283 ($): 73.69] [ED Level 4--99284 ($): 123.51] [ED Level 5--99285 ($): 223.93] [Clinic Visit ($): 59.34] [OP High Cost Drugs (%BC): 40] [Other Outpatient Implant (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"1 through 10","median_amount":223.56,"10th_percentile":223.56,"90th_percentile":479.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 5 Minor Procedures","code_information":[{"code":"5735","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 84] [OP Surgery  (%BC): 84] [Observation (%BC): 84] [Emergency Department (%BC): 84] [Occupational Therapy (%BC): 84] [Physical Therapy (%BC): 84] [Respiratory Services/Therapy  (%BC): 84] [Speech Therapy (%BC): 84] [All Other OP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41.82] [OP Surgery  (%BC): 41.82] [Observation (%BC): 41.82] [Emergency Department (%BC): 41.82] [Occupational Therapy (%BC): 41.82] [Physical Therapy (%BC): 41.82] [Respiratory Services/Therapy  (%BC): 41.82] [Speech Therapy (%BC): 41.82] [All Other OP (%BC): 41.82]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [All OP services (%BC): 77.4] [OP Surgery  (%BC): 77.4] [Observation (%BC): 77.4] [Emergency Department (%BC): 77.4] [Occupational Therapy (%BC): 77.4] [Physical Therapy (%BC): 77.4] [Respiratory Services/Therapy  (%BC): 77.4] [Speech Therapy (%BC): 77.4] [All Other OP (%BC): 77.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41] [OP Surgery  (%BC): 41] [Observation (%BC): 41] [Emergency Department (%BC): 41] [Occupational Therapy (%BC): 41] [Physical Therapy (%BC): 41] [Respiratory Services/Therapy  (%BC): 41] [Speech Therapy (%BC): 41] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 60.6] [OP Surgery  (%BC): 60.6] [Observation (%BC): 60.6] [Emergency Department (%BC): 60.6] [Occupational Therapy (%BC): 60.6] [Physical Therapy (%BC): 60.6] [Respiratory Services/Therapy  (%BC): 60.6] [Speech Therapy (%BC): 60.6] [All Other OP (%BC): 60.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Bluecard Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [Emergency Department ($): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 79.2] [OP Surgery  (%BC): 79.2] [Observation (%BC): 79.2] [Emergency Department (%BC): 79.2] [Occupational Therapy (%BC): 79.2] [Physical Therapy (%BC): 79.2] [Respiratory Services/Therapy  (%BC): 79.2] [Speech Therapy (%BC): 79.2] [All Other OP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74] [Observation (%BC): 74] [Emergency Department (%BC): 74] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 74] [Physical Therapy (%BC): 74] [Respiratory Services/Therapy  (%BC): 74] [Speech Therapy (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 78] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 39] [OP Surgery  (%BC): 39] [Observation (%BC): 39] [Emergency Department (%BC): 39] [Occupational Therapy (%BC): 39] [Physical Therapy (%BC): 39] [Respiratory Services/Therapy  (%BC): 39] [Speech Therapy (%BC): 39] [All Other OP (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Mycare Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 75] [OP Surgery  (%BC): 75] [Observation (%BC): 75] [Emergency Department (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [All Other OP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72] [OP Surgery  (%BC): 72] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 72] [Physical Therapy (%BC): 72] [Respiratory Services/Therapy  (%BC): 72] [Speech Therapy (%BC): 72] [All Other OP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [ED Level 1--99281 ($): 27.09] [ED Level 2--99282 ($): 41.69] [ED Level 3--99283 ($): 73.69] [ED Level 4--99284 ($): 123.51] [ED Level 5--99285 ($): 223.93] [Clinic Visit ($): 59.34] [OP High Cost Drugs (%BC): 40] [Other Outpatient Implant (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"1 through 10","median_amount":2112.86,"10th_percentile":2112.86,"90th_percentile":2112.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Electronic Analysis of Devices","code_information":[{"code":"5741","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 84] [OP Surgery  (%BC): 84] [Observation (%BC): 84] [Emergency Department (%BC): 84] [Occupational Therapy (%BC): 84] [Physical Therapy (%BC): 84] [Respiratory Services/Therapy  (%BC): 84] [Speech Therapy (%BC): 84] [All Other OP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41.82] [OP Surgery  (%BC): 41.82] [Observation (%BC): 41.82] [Emergency Department (%BC): 41.82] [Occupational Therapy (%BC): 41.82] [Physical Therapy (%BC): 41.82] [Respiratory Services/Therapy  (%BC): 41.82] [Speech Therapy (%BC): 41.82] [All Other OP (%BC): 41.82]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [All OP services (%BC): 77.4] [OP Surgery  (%BC): 77.4] [Observation (%BC): 77.4] [Emergency Department (%BC): 77.4] [Occupational Therapy (%BC): 77.4] [Physical Therapy (%BC): 77.4] [Respiratory Services/Therapy  (%BC): 77.4] [Speech Therapy (%BC): 77.4] [All Other OP (%BC): 77.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41] [OP Surgery  (%BC): 41] [Observation (%BC): 41] [Emergency Department (%BC): 41] [Occupational Therapy (%BC): 41] [Physical Therapy (%BC): 41] [Respiratory Services/Therapy  (%BC): 41] [Speech Therapy (%BC): 41] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 60.6] [OP Surgery  (%BC): 60.6] [Observation (%BC): 60.6] [Emergency Department (%BC): 60.6] [Occupational Therapy (%BC): 60.6] [Physical Therapy (%BC): 60.6] [Respiratory Services/Therapy  (%BC): 60.6] [Speech Therapy (%BC): 60.6] [All Other OP (%BC): 60.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Bluecard Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [Emergency Department ($): 40]","count":"1 through 10","median_amount":134.86,"10th_percentile":134.86,"90th_percentile":134.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 79.2] [OP Surgery  (%BC): 79.2] [Observation (%BC): 79.2] [Emergency Department (%BC): 79.2] [Occupational Therapy (%BC): 79.2] [Physical Therapy (%BC): 79.2] [Respiratory Services/Therapy  (%BC): 79.2] [Speech Therapy (%BC): 79.2] [All Other OP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74] [Observation (%BC): 74] [Emergency Department (%BC): 74] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 74] [Physical Therapy (%BC): 74] [Respiratory Services/Therapy  (%BC): 74] [Speech Therapy (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 78] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 39] [OP Surgery  (%BC): 39] [Observation (%BC): 39] [Emergency Department (%BC): 39] [Occupational Therapy (%BC): 39] [Physical Therapy (%BC): 39] [Respiratory Services/Therapy  (%BC): 39] [Speech Therapy (%BC): 39] [All Other OP (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Mycare Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 75] [OP Surgery  (%BC): 75] [Observation (%BC): 75] [Emergency Department (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [All Other OP (%BC): 75]","count":"1 through 10","median_amount":159.8,"10th_percentile":159.8,"90th_percentile":159.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72] [OP Surgery  (%BC): 72] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 72] [Physical Therapy (%BC): 72] [Respiratory Services/Therapy  (%BC): 72] [Speech Therapy (%BC): 72] [All Other OP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [ED Level 1--99281 ($): 27.09] [ED Level 2--99282 ($): 41.69] [ED Level 3--99283 ($): 73.69] [ED Level 4--99284 ($): 123.51] [ED Level 5--99285 ($): 223.93] [Clinic Visit ($): 59.34] [OP High Cost Drugs (%BC): 40] [Other Outpatient Implant (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Rehabilitation","code_information":[{"code":"5771","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 84] [OP Surgery  (%BC): 84] [Observation (%BC): 84] [Emergency Department (%BC): 84] [Occupational Therapy (%BC): 84] [Physical Therapy (%BC): 84] [Respiratory Services/Therapy  (%BC): 84] [Speech Therapy (%BC): 84] [All Other OP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41.82] [OP Surgery  (%BC): 41.82] [Observation (%BC): 41.82] [Emergency Department (%BC): 41.82] [Occupational Therapy (%BC): 41.82] [Physical Therapy (%BC): 41.82] [Respiratory Services/Therapy  (%BC): 41.82] [Speech Therapy (%BC): 41.82] [All Other OP (%BC): 41.82]","count":"1 through 10","median_amount":432.92,"10th_percentile":324.69,"90th_percentile":1104.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [All OP services (%BC): 77.4] [OP Surgery  (%BC): 77.4] [Observation (%BC): 77.4] [Emergency Department (%BC): 77.4] [Occupational Therapy (%BC): 77.4] [Physical Therapy (%BC): 77.4] [Respiratory Services/Therapy  (%BC): 77.4] [Speech Therapy (%BC): 77.4] [All Other OP (%BC): 77.4]","count":"1 through 10","median_amount":1502.62,"10th_percentile":1502.62,"90th_percentile":1502.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41] [OP Surgery  (%BC): 41] [Observation (%BC): 41] [Emergency Department (%BC): 41] [Occupational Therapy (%BC): 41] [Physical Therapy (%BC): 41] [Respiratory Services/Therapy  (%BC): 41] [Speech Therapy (%BC): 41] [All Other OP (%BC): 41]","count":"1 through 10","median_amount":197.3,"10th_percentile":197.3,"90th_percentile":197.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 60.6] [OP Surgery  (%BC): 60.6] [Observation (%BC): 60.6] [Emergency Department (%BC): 60.6] [Occupational Therapy (%BC): 60.6] [Physical Therapy (%BC): 60.6] [Respiratory Services/Therapy  (%BC): 60.6] [Speech Therapy (%BC): 60.6] [All Other OP (%BC): 60.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Bluecard Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":986.5,"10th_percentile":986.5,"90th_percentile":986.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [Emergency Department ($): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 79.2] [OP Surgery  (%BC): 79.2] [Observation (%BC): 79.2] [Emergency Department (%BC): 79.2] [Occupational Therapy (%BC): 79.2] [Physical Therapy (%BC): 79.2] [Respiratory Services/Therapy  (%BC): 79.2] [Speech Therapy (%BC): 79.2] [All Other OP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74] [Observation (%BC): 74] [Emergency Department (%BC): 74] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 74] [Physical Therapy (%BC): 74] [Respiratory Services/Therapy  (%BC): 74] [Speech Therapy (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 78] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 39] [OP Surgery  (%BC): 39] [Observation (%BC): 39] [Emergency Department (%BC): 39] [Occupational Therapy (%BC): 39] [Physical Therapy (%BC): 39] [Respiratory Services/Therapy  (%BC): 39] [Speech Therapy (%BC): 39] [All Other OP (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"1 through 10","median_amount":921.69,"10th_percentile":921.69,"90th_percentile":921.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Mycare Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 75] [OP Surgery  (%BC): 75] [Observation (%BC): 75] [Emergency Department (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [All Other OP (%BC): 75]","count":"1 through 10","median_amount":466.75,"10th_percentile":466.75,"90th_percentile":466.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72] [OP Surgery  (%BC): 72] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 72] [Physical Therapy (%BC): 72] [Respiratory Services/Therapy  (%BC): 72] [Speech Therapy (%BC): 72] [All Other OP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"1 through 10","median_amount":3052.27,"10th_percentile":3052.27,"90th_percentile":3052.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [ED Level 1--99281 ($): 27.09] [ED Level 2--99282 ($): 41.69] [ED Level 3--99283 ($): 73.69] [ED Level 4--99284 ($): 123.51] [ED Level 5--99285 ($): 223.93] [Clinic Visit ($): 59.34] [OP High Cost Drugs (%BC): 40] [Other Outpatient Implant (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"1 through 10","median_amount":1675.87,"10th_percentile":1675.87,"90th_percentile":1675.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Resuscitation and Cardioversion","code_information":[{"code":"5781","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 84] [OP Surgery  (%BC): 84] [Observation (%BC): 84] [Emergency Department (%BC): 84] [Occupational Therapy (%BC): 84] [Physical Therapy (%BC): 84] [Respiratory Services/Therapy  (%BC): 84] [Speech Therapy (%BC): 84] [All Other OP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":1190.61,"10th_percentile":1190.61,"90th_percentile":1190.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41.82] [OP Surgery  (%BC): 41.82] [Observation (%BC): 41.82] [Emergency Department (%BC): 41.82] [Occupational Therapy (%BC): 41.82] [Physical Therapy (%BC): 41.82] [Respiratory Services/Therapy  (%BC): 41.82] [Speech Therapy (%BC): 41.82] [All Other OP (%BC): 41.82]","count":"1 through 10","median_amount":1404.38,"10th_percentile":1400.07,"90th_percentile":2283.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [All OP services (%BC): 77.4] [OP Surgery  (%BC): 77.4] [Observation (%BC): 77.4] [Emergency Department (%BC): 77.4] [Occupational Therapy (%BC): 77.4] [Physical Therapy (%BC): 77.4] [Respiratory Services/Therapy  (%BC): 77.4] [Speech Therapy (%BC): 77.4] [All Other OP (%BC): 77.4]","count":"1 through 10","median_amount":2956.11,"10th_percentile":2719.47,"90th_percentile":3759.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41] [OP Surgery  (%BC): 41] [Observation (%BC): 41] [Emergency Department (%BC): 41] [Occupational Therapy (%BC): 41] [Physical Therapy (%BC): 41] [Respiratory Services/Therapy  (%BC): 41] [Speech Therapy (%BC): 41] [All Other OP (%BC): 41]","count":"1 through 10","median_amount":1515.25,"10th_percentile":1515.25,"90th_percentile":1515.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 60.6] [OP Surgery  (%BC): 60.6] [Observation (%BC): 60.6] [Emergency Department (%BC): 60.6] [Occupational Therapy (%BC): 60.6] [Physical Therapy (%BC): 60.6] [Respiratory Services/Therapy  (%BC): 60.6] [Speech Therapy (%BC): 60.6] [All Other OP (%BC): 60.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Bluecard Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [Emergency Department ($): 40]","count":"1 through 10","median_amount":1100.81,"10th_percentile":1100.81,"90th_percentile":1100.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 79.2] [OP Surgery  (%BC): 79.2] [Observation (%BC): 79.2] [Emergency Department (%BC): 79.2] [Occupational Therapy (%BC): 79.2] [Physical Therapy (%BC): 79.2] [Respiratory Services/Therapy  (%BC): 79.2] [Speech Therapy (%BC): 79.2] [All Other OP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74] [Observation (%BC): 74] [Emergency Department (%BC): 74] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 74] [Physical Therapy (%BC): 74] [Respiratory Services/Therapy  (%BC): 74] [Speech Therapy (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 78] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 39] [OP Surgery  (%BC): 39] [Observation (%BC): 39] [Emergency Department (%BC): 39] [Occupational Therapy (%BC): 39] [Physical Therapy (%BC): 39] [Respiratory Services/Therapy  (%BC): 39] [Speech Therapy (%BC): 39] [All Other OP (%BC): 39]","count":"1 through 10","median_amount":1257.08,"10th_percentile":1257.08,"90th_percentile":1257.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Mycare Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 75] [OP Surgery  (%BC): 75] [Observation (%BC): 75] [Emergency Department (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [All Other OP (%BC): 75]","count":"1 through 10","median_amount":967.39,"10th_percentile":967.39,"90th_percentile":967.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72] [OP Surgery  (%BC): 72] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 72] [Physical Therapy (%BC): 72] [Respiratory Services/Therapy  (%BC): 72] [Speech Therapy (%BC): 72] [All Other OP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [ED Level 1--99281 ($): 27.09] [ED Level 2--99282 ($): 41.69] [ED Level 3--99283 ($): 73.69] [ED Level 4--99284 ($): 123.51] [ED Level 5--99285 ($): 223.93] [Clinic Visit ($): 59.34] [OP High Cost Drugs (%BC): 40] [Other Outpatient Implant (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"1 through 10","median_amount":3173.76,"10th_percentile":3173.76,"90th_percentile":3173.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pulmonary Treatment","code_information":[{"code":"5791","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 84] [OP Surgery  (%BC): 84] [Observation (%BC): 84] [Emergency Department (%BC): 84] [Occupational Therapy (%BC): 84] [Physical Therapy (%BC): 84] [Respiratory Services/Therapy  (%BC): 84] [Speech Therapy (%BC): 84] [All Other OP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41.82] [OP Surgery  (%BC): 41.82] [Observation (%BC): 41.82] [Emergency Department (%BC): 41.82] [Occupational Therapy (%BC): 41.82] [Physical Therapy (%BC): 41.82] [Respiratory Services/Therapy  (%BC): 41.82] [Speech Therapy (%BC): 41.82] [All Other OP (%BC): 41.82]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [All OP services (%BC): 77.4] [OP Surgery  (%BC): 77.4] [Observation (%BC): 77.4] [Emergency Department (%BC): 77.4] [Occupational Therapy (%BC): 77.4] [Physical Therapy (%BC): 77.4] [Respiratory Services/Therapy  (%BC): 77.4] [Speech Therapy (%BC): 77.4] [All Other OP (%BC): 77.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41] [OP Surgery  (%BC): 41] [Observation (%BC): 41] [Emergency Department (%BC): 41] [Occupational Therapy (%BC): 41] [Physical Therapy (%BC): 41] [Respiratory Services/Therapy  (%BC): 41] [Speech Therapy (%BC): 41] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 60.6] [OP Surgery  (%BC): 60.6] [Observation (%BC): 60.6] [Emergency Department (%BC): 60.6] [Occupational Therapy (%BC): 60.6] [Physical Therapy (%BC): 60.6] [Respiratory Services/Therapy  (%BC): 60.6] [Speech Therapy (%BC): 60.6] [All Other OP (%BC): 60.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Bluecard Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [Emergency Department ($): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 79.2] [OP Surgery  (%BC): 79.2] [Observation (%BC): 79.2] [Emergency Department (%BC): 79.2] [Occupational Therapy (%BC): 79.2] [Physical Therapy (%BC): 79.2] [Respiratory Services/Therapy  (%BC): 79.2] [Speech Therapy (%BC): 79.2] [All Other OP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74] [Observation (%BC): 74] [Emergency Department (%BC): 74] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 74] [Physical Therapy (%BC): 74] [Respiratory Services/Therapy  (%BC): 74] [Speech Therapy (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 78] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 39] [OP Surgery  (%BC): 39] [Observation (%BC): 39] [Emergency Department (%BC): 39] [Occupational Therapy (%BC): 39] [Physical Therapy (%BC): 39] [Respiratory Services/Therapy  (%BC): 39] [Speech Therapy (%BC): 39] [All Other OP (%BC): 39]","count":"1 through 10","median_amount":1284.68,"10th_percentile":1284.68,"90th_percentile":1284.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Mycare Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 75] [OP Surgery  (%BC): 75] [Observation (%BC): 75] [Emergency Department (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [All Other OP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72] [OP Surgery  (%BC): 72] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 72] [Physical Therapy (%BC): 72] [Respiratory Services/Therapy  (%BC): 72] [Speech Therapy (%BC): 72] [All Other OP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [ED Level 1--99281 ($): 27.09] [ED Level 2--99282 ($): 41.69] [ED Level 3--99283 ($): 73.69] [ED Level 4--99284 ($): 123.51] [ED Level 5--99285 ($): 223.93] [Clinic Visit ($): 59.34] [OP High Cost Drugs (%BC): 40] [Other Outpatient Implant (%BC): 40]","count":"1 through 10","median_amount":756.55,"10th_percentile":756.55,"90th_percentile":756.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventilation Initiation and Management","code_information":[{"code":"5801","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 84] [OP Surgery  (%BC): 84] [Observation (%BC): 84] [Emergency Department (%BC): 84] [Occupational Therapy (%BC): 84] [Physical Therapy (%BC): 84] [Respiratory Services/Therapy  (%BC): 84] [Speech Therapy (%BC): 84] [All Other OP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41.82] [OP Surgery  (%BC): 41.82] [Observation (%BC): 41.82] [Emergency Department (%BC): 41.82] [Occupational Therapy (%BC): 41.82] [Physical Therapy (%BC): 41.82] [Respiratory Services/Therapy  (%BC): 41.82] [Speech Therapy (%BC): 41.82] [All Other OP (%BC): 41.82]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [All OP services (%BC): 77.4] [OP Surgery  (%BC): 77.4] [Observation (%BC): 77.4] [Emergency Department (%BC): 77.4] [Occupational Therapy (%BC): 77.4] [Physical Therapy (%BC): 77.4] [Respiratory Services/Therapy  (%BC): 77.4] [Speech Therapy (%BC): 77.4] [All Other OP (%BC): 77.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41] [OP Surgery  (%BC): 41] [Observation (%BC): 41] [Emergency Department (%BC): 41] [Occupational Therapy (%BC): 41] [Physical Therapy (%BC): 41] [Respiratory Services/Therapy  (%BC): 41] [Speech Therapy (%BC): 41] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 60.6] [OP Surgery  (%BC): 60.6] [Observation (%BC): 60.6] [Emergency Department (%BC): 60.6] [Occupational Therapy (%BC): 60.6] [Physical Therapy (%BC): 60.6] [Respiratory Services/Therapy  (%BC): 60.6] [Speech Therapy (%BC): 60.6] [All Other OP (%BC): 60.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Bluecard Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":4960.43,"10th_percentile":4960.43,"90th_percentile":4960.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [Emergency Department ($): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 79.2] [OP Surgery  (%BC): 79.2] [Observation (%BC): 79.2] [Emergency Department (%BC): 79.2] [Occupational Therapy (%BC): 79.2] [Physical Therapy (%BC): 79.2] [Respiratory Services/Therapy  (%BC): 79.2] [Speech Therapy (%BC): 79.2] [All Other OP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74] [Observation (%BC): 74] [Emergency Department (%BC): 74] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 74] [Physical Therapy (%BC): 74] [Respiratory Services/Therapy  (%BC): 74] [Speech Therapy (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 78] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 39] [OP Surgery  (%BC): 39] [Observation (%BC): 39] [Emergency Department (%BC): 39] [Occupational Therapy (%BC): 39] [Physical Therapy (%BC): 39] [Respiratory Services/Therapy  (%BC): 39] [Speech Therapy (%BC): 39] [All Other OP (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Mycare Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 75] [OP Surgery  (%BC): 75] [Observation (%BC): 75] [Emergency Department (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [All Other OP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72] [OP Surgery  (%BC): 72] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 72] [Physical Therapy (%BC): 72] [Respiratory Services/Therapy  (%BC): 72] [Speech Therapy (%BC): 72] [All Other OP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [ED Level 1--99281 ($): 27.09] [ED Level 2--99282 ($): 41.69] [ED Level 3--99283 ($): 73.69] [ED Level 4--99284 ($): 123.51] [ED Level 5--99285 ($): 223.93] [Clinic Visit ($): 59.34] [OP High Cost Drugs (%BC): 40] [Other Outpatient Implant (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Health and Behavior Services","code_information":[{"code":"5821","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 84] [OP Surgery  (%BC): 84] [Observation (%BC): 84] [Emergency Department (%BC): 84] [Occupational Therapy (%BC): 84] [Physical Therapy (%BC): 84] [Respiratory Services/Therapy  (%BC): 84] [Speech Therapy (%BC): 84] [All Other OP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41.82] [OP Surgery  (%BC): 41.82] [Observation (%BC): 41.82] [Emergency Department (%BC): 41.82] [Occupational Therapy (%BC): 41.82] [Physical Therapy (%BC): 41.82] [Respiratory Services/Therapy  (%BC): 41.82] [Speech Therapy (%BC): 41.82] [All Other OP (%BC): 41.82]","count":"1 through 10","median_amount":3.05,"10th_percentile":3.05,"90th_percentile":3.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [All OP services (%BC): 77.4] [OP Surgery  (%BC): 77.4] [Observation (%BC): 77.4] [Emergency Department (%BC): 77.4] [Occupational Therapy (%BC): 77.4] [Physical Therapy (%BC): 77.4] [Respiratory Services/Therapy  (%BC): 77.4] [Speech Therapy (%BC): 77.4] [All Other OP (%BC): 77.4]","count":"1 through 10","median_amount":96.48,"10th_percentile":64.32,"90th_percentile":96.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41] [OP Surgery  (%BC): 41] [Observation (%BC): 41] [Emergency Department (%BC): 41] [Occupational Therapy (%BC): 41] [Physical Therapy (%BC): 41] [Respiratory Services/Therapy  (%BC): 41] [Speech Therapy (%BC): 41] [All Other OP (%BC): 41]","count":"1 through 10","median_amount":33.6,"10th_percentile":33.6,"90th_percentile":33.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 60.6] [OP Surgery  (%BC): 60.6] [Observation (%BC): 60.6] [Emergency Department (%BC): 60.6] [Occupational Therapy (%BC): 60.6] [Physical Therapy (%BC): 60.6] [Respiratory Services/Therapy  (%BC): 60.6] [Speech Therapy (%BC): 60.6] [All Other OP (%BC): 60.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Bluecard Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [Emergency Department ($): 40]","count":"1 through 10","median_amount":20.0,"10th_percentile":20.0,"90th_percentile":20.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":20.0,"10th_percentile":10.0,"90th_percentile":20.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 79.2] [OP Surgery  (%BC): 79.2] [Observation (%BC): 79.2] [Emergency Department (%BC): 79.2] [Occupational Therapy (%BC): 79.2] [Physical Therapy (%BC): 79.2] [Respiratory Services/Therapy  (%BC): 79.2] [Speech Therapy (%BC): 79.2] [All Other OP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74] [Observation (%BC): 74] [Emergency Department (%BC): 74] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 74] [Physical Therapy (%BC): 74] [Respiratory Services/Therapy  (%BC): 74] [Speech Therapy (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 78] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"1 through 10","median_amount":10.0,"10th_percentile":10.0,"90th_percentile":10.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 39] [OP Surgery  (%BC): 39] [Observation (%BC): 39] [Emergency Department (%BC): 39] [Occupational Therapy (%BC): 39] [Physical Therapy (%BC): 39] [Respiratory Services/Therapy  (%BC): 39] [Speech Therapy (%BC): 39] [All Other OP (%BC): 39]","count":"1 through 10","median_amount":2.93,"10th_percentile":2.93,"90th_percentile":2.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"1 through 10","median_amount":3.02,"10th_percentile":3.02,"90th_percentile":3.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Mycare Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 75] [OP Surgery  (%BC): 75] [Observation (%BC): 75] [Emergency Department (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [All Other OP (%BC): 75]","count":"1 through 10","median_amount":2.78,"10th_percentile":2.78,"90th_percentile":2.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72] [OP Surgery  (%BC): 72] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 72] [Physical Therapy (%BC): 72] [Respiratory Services/Therapy  (%BC): 72] [Speech Therapy (%BC): 72] [All Other OP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [ED Level 1--99281 ($): 27.09] [ED Level 2--99282 ($): 41.69] [ED Level 3--99283 ($): 73.69] [ED Level 4--99284 ($): 123.51] [ED Level 5--99285 ($): 223.93] [Clinic Visit ($): 59.34] [OP High Cost Drugs (%BC): 40] [Other Outpatient Implant (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Health and Behavior Services","code_information":[{"code":"5823","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 84] [OP Surgery  (%BC): 84] [Observation (%BC): 84] [Emergency Department (%BC): 84] [Occupational Therapy (%BC): 84] [Physical Therapy (%BC): 84] [Respiratory Services/Therapy  (%BC): 84] [Speech Therapy (%BC): 84] [All Other OP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41.82] [OP Surgery  (%BC): 41.82] [Observation (%BC): 41.82] [Emergency Department (%BC): 41.82] [Occupational Therapy (%BC): 41.82] [Physical Therapy (%BC): 41.82] [Respiratory Services/Therapy  (%BC): 41.82] [Speech Therapy (%BC): 41.82] [All Other OP (%BC): 41.82]","count":"1 through 10","median_amount":733.7,"10th_percentile":733.7,"90th_percentile":733.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [All OP services (%BC): 77.4] [OP Surgery  (%BC): 77.4] [Observation (%BC): 77.4] [Emergency Department (%BC): 77.4] [Occupational Therapy (%BC): 77.4] [Physical Therapy (%BC): 77.4] [Respiratory Services/Therapy  (%BC): 77.4] [Speech Therapy (%BC): 77.4] [All Other OP (%BC): 77.4]","count":"1 through 10","median_amount":1208.72,"10th_percentile":941.75,"90th_percentile":3470.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"1 through 10","median_amount":839.75,"10th_percentile":839.75,"90th_percentile":839.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41] [OP Surgery  (%BC): 41] [Observation (%BC): 41] [Emergency Department (%BC): 41] [Occupational Therapy (%BC): 41] [Physical Therapy (%BC): 41] [Respiratory Services/Therapy  (%BC): 41] [Speech Therapy (%BC): 41] [All Other OP (%BC): 41]","count":"1 through 10","median_amount":996.51,"10th_percentile":996.51,"90th_percentile":1434.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 60.6] [OP Surgery  (%BC): 60.6] [Observation (%BC): 60.6] [Emergency Department (%BC): 60.6] [Occupational Therapy (%BC): 60.6] [Physical Therapy (%BC): 60.6] [Respiratory Services/Therapy  (%BC): 60.6] [Speech Therapy (%BC): 60.6] [All Other OP (%BC): 60.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Bluecard Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [Emergency Department ($): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 79.2] [OP Surgery  (%BC): 79.2] [Observation (%BC): 79.2] [Emergency Department (%BC): 79.2] [Occupational Therapy (%BC): 79.2] [Physical Therapy (%BC): 79.2] [Respiratory Services/Therapy  (%BC): 79.2] [Speech Therapy (%BC): 79.2] [All Other OP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74] [Observation (%BC): 74] [Emergency Department (%BC): 74] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 74] [Physical Therapy (%BC): 74] [Respiratory Services/Therapy  (%BC): 74] [Speech Therapy (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 78] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 39] [OP Surgery  (%BC): 39] [Observation (%BC): 39] [Emergency Department (%BC): 39] [Occupational Therapy (%BC): 39] [Physical Therapy (%BC): 39] [Respiratory Services/Therapy  (%BC): 39] [Speech Therapy (%BC): 39] [All Other OP (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"1 through 10","median_amount":1239.89,"10th_percentile":1239.89,"90th_percentile":4014.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":1084.32,"10th_percentile":1084.32,"90th_percentile":1084.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Mycare Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 75] [OP Surgery  (%BC): 75] [Observation (%BC): 75] [Emergency Department (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [All Other OP (%BC): 75]","count":"1 through 10","median_amount":813.04,"10th_percentile":813.04,"90th_percentile":813.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72] [OP Surgery  (%BC): 72] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 72] [Physical Therapy (%BC): 72] [Respiratory Services/Therapy  (%BC): 72] [Speech Therapy (%BC): 72] [All Other OP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"1 through 10","median_amount":2878.73,"10th_percentile":2878.73,"90th_percentile":2878.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [ED Level 1--99281 ($): 27.09] [ED Level 2--99282 ($): 41.69] [ED Level 3--99283 ($): 73.69] [ED Level 4--99284 ($): 123.51] [ED Level 5--99285 ($): 223.93] [Clinic Visit ($): 59.34] [OP High Cost Drugs (%BC): 40] [Other Outpatient Implant (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Clinical Diagnostic Lab Services","code_information":[{"code":"N800","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 84] [OP Surgery  (%BC): 84] [Observation (%BC): 84] [Emergency Department (%BC): 84] [Occupational Therapy (%BC): 84] [Physical Therapy (%BC): 84] [Respiratory Services/Therapy  (%BC): 84] [Speech Therapy (%BC): 84] [All Other OP (%BC): 84]","count":"189","median_amount":183.58,"10th_percentile":76.75,"90th_percentile":475.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"115","median_amount":85.98,"10th_percentile":29.7,"90th_percentile":233.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41.82] [OP Surgery  (%BC): 41.82] [Observation (%BC): 41.82] [Emergency Department (%BC): 41.82] [Occupational Therapy (%BC): 41.82] [Physical Therapy (%BC): 41.82] [Respiratory Services/Therapy  (%BC): 41.82] [Speech Therapy (%BC): 41.82] [All Other OP (%BC): 41.82]","count":"1333","median_amount":95.44,"10th_percentile":34.82,"90th_percentile":242.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":112.62,"10th_percentile":55.95,"90th_percentile":188.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [All OP services (%BC): 77.4] [OP Surgery  (%BC): 77.4] [Observation (%BC): 77.4] [Emergency Department (%BC): 77.4] [Occupational Therapy (%BC): 77.4] [Physical Therapy (%BC): 77.4] [Respiratory Services/Therapy  (%BC): 77.4] [Speech Therapy (%BC): 77.4] [All Other OP (%BC): 77.4]","count":"2581","median_amount":166.75,"10th_percentile":37.56,"90th_percentile":463.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"102","median_amount":105.85,"10th_percentile":38.02,"90th_percentile":212.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41] [OP Surgery  (%BC): 41] [Observation (%BC): 41] [Emergency Department (%BC): 41] [Occupational Therapy (%BC): 41] [Physical Therapy (%BC): 41] [Respiratory Services/Therapy  (%BC): 41] [Speech Therapy (%BC): 41] [All Other OP (%BC): 41]","count":"860","median_amount":95.26,"10th_percentile":24.36,"90th_percentile":242.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 60.6] [OP Surgery  (%BC): 60.6] [Observation (%BC): 60.6] [Emergency Department (%BC): 60.6] [Occupational Therapy (%BC): 60.6] [Physical Therapy (%BC): 60.6] [Respiratory Services/Therapy  (%BC): 60.6] [Speech Therapy (%BC): 60.6] [All Other OP (%BC): 60.6]","count":"112","median_amount":156.28,"10th_percentile":57.01,"90th_percentile":456.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Bluecard Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"190","median_amount":101.93,"10th_percentile":37.79,"90th_percentile":229.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [Emergency Department ($): 40]","count":"662","median_amount":41.47,"10th_percentile":25.04,"90th_percentile":178.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"163","median_amount":58.85,"10th_percentile":25.91,"90th_percentile":165.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 79.2] [OP Surgery  (%BC): 79.2] [Observation (%BC): 79.2] [Emergency Department (%BC): 79.2] [Occupational Therapy (%BC): 79.2] [Physical Therapy (%BC): 79.2] [Respiratory Services/Therapy  (%BC): 79.2] [Speech Therapy (%BC): 79.2] [All Other OP (%BC): 79.2]","count":"56","median_amount":253.05,"10th_percentile":73.06,"90th_percentile":568.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"12","median_amount":336.9,"10th_percentile":162.2,"90th_percentile":579.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74] [Observation (%BC): 74] [Emergency Department (%BC): 74] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 74] [Physical Therapy (%BC): 74] [Respiratory Services/Therapy  (%BC): 74] [Speech Therapy (%BC): 74] [All Other OP (%BC): 74]","count":"37","median_amount":251.8,"10th_percentile":90.29,"90th_percentile":584.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 78] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [All Other OP (%BC): 78]","count":"1 through 10","median_amount":223.9,"10th_percentile":113.17,"90th_percentile":369.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"227","median_amount":48.88,"10th_percentile":26.29,"90th_percentile":179.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 39] [OP Surgery  (%BC): 39] [Observation (%BC): 39] [Emergency Department (%BC): 39] [Occupational Therapy (%BC): 39] [Physical Therapy (%BC): 39] [Respiratory Services/Therapy  (%BC): 39] [Speech Therapy (%BC): 39] [All Other OP (%BC): 39]","count":"513","median_amount":82.89,"10th_percentile":8.88,"90th_percentile":236.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"1261","median_amount":178.65,"10th_percentile":57.82,"90th_percentile":436.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"56","median_amount":48.93,"10th_percentile":18.85,"90th_percentile":140.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Mycare Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"1 through 10","median_amount":25.0,"10th_percentile":25.0,"90th_percentile":25.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"1 through 10","median_amount":322.6,"10th_percentile":285.0,"90th_percentile":561.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 75] [OP Surgery  (%BC): 75] [Observation (%BC): 75] [Emergency Department (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [All Other OP (%BC): 75]","count":"963","median_amount":114.23,"10th_percentile":31.71,"90th_percentile":350.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72] [OP Surgery  (%BC): 72] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 72] [Physical Therapy (%BC): 72] [Respiratory Services/Therapy  (%BC): 72] [Speech Therapy (%BC): 72] [All Other OP (%BC): 72]","count":"1 through 10","median_amount":182.07,"10th_percentile":90.05,"90th_percentile":507.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"1 through 10","median_amount":214.95,"10th_percentile":214.95,"90th_percentile":214.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"327","median_amount":263.18,"10th_percentile":80.93,"90th_percentile":638.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"113","median_amount":208.66,"10th_percentile":87.68,"90th_percentile":608.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [ED Level 1--99281 ($): 27.09] [ED Level 2--99282 ($): 41.69] [ED Level 3--99283 ($): 73.69] [ED Level 4--99284 ($): 123.51] [ED Level 5--99285 ($): 223.93] [Clinic Visit ($): 59.34] [OP High Cost Drugs (%BC): 40] [Other Outpatient Implant (%BC): 40]","count":"144","median_amount":66.71,"10th_percentile":25.91,"90th_percentile":181.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"471","median_amount":132.23,"10th_percentile":31.95,"90th_percentile":410.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"26","median_amount":178.15,"10th_percentile":56.08,"90th_percentile":275.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"48","median_amount":98.59,"10th_percentile":19.4,"90th_percentile":243.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Therapy Services","code_information":[{"code":"N801","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 84] [OP Surgery  (%BC): 84] [Observation (%BC): 84] [Emergency Department (%BC): 84] [Occupational Therapy (%BC): 84] [Physical Therapy (%BC): 84] [Respiratory Services/Therapy  (%BC): 84] [Speech Therapy (%BC): 84] [All Other OP (%BC): 84]","count":"1 through 10","median_amount":168.21,"10th_percentile":168.21,"90th_percentile":168.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41.82] [OP Surgery  (%BC): 41.82] [Observation (%BC): 41.82] [Emergency Department (%BC): 41.82] [Occupational Therapy (%BC): 41.82] [Physical Therapy (%BC): 41.82] [Respiratory Services/Therapy  (%BC): 41.82] [Speech Therapy (%BC): 41.82] [All Other OP (%BC): 41.82]","count":"11","median_amount":876.11,"10th_percentile":157.34,"90th_percentile":1200.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [All OP services (%BC): 77.4] [OP Surgery  (%BC): 77.4] [Observation (%BC): 77.4] [Emergency Department (%BC): 77.4] [Occupational Therapy (%BC): 77.4] [Physical Therapy (%BC): 77.4] [Respiratory Services/Therapy  (%BC): 77.4] [Speech Therapy (%BC): 77.4] [All Other OP (%BC): 77.4]","count":"11","median_amount":886.21,"10th_percentile":132.43,"90th_percentile":1618.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41] [OP Surgery  (%BC): 41] [Observation (%BC): 41] [Emergency Department (%BC): 41] [Occupational Therapy (%BC): 41] [Physical Therapy (%BC): 41] [Respiratory Services/Therapy  (%BC): 41] [Speech Therapy (%BC): 41] [All Other OP (%BC): 41]","count":"1 through 10","median_amount":757.35,"10th_percentile":327.04,"90th_percentile":785.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 60.6] [OP Surgery  (%BC): 60.6] [Observation (%BC): 60.6] [Emergency Department (%BC): 60.6] [Occupational Therapy (%BC): 60.6] [Physical Therapy (%BC): 60.6] [Respiratory Services/Therapy  (%BC): 60.6] [Speech Therapy (%BC): 60.6] [All Other OP (%BC): 60.6]","count":"1 through 10","median_amount":700.44,"10th_percentile":700.44,"90th_percentile":700.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Bluecard Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [Emergency Department ($): 40]","count":"1 through 10","median_amount":409.91,"10th_percentile":397.28,"90th_percentile":972.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":409.91,"10th_percentile":409.91,"90th_percentile":595.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 79.2] [OP Surgery  (%BC): 79.2] [Observation (%BC): 79.2] [Emergency Department (%BC): 79.2] [Occupational Therapy (%BC): 79.2] [Physical Therapy (%BC): 79.2] [Respiratory Services/Therapy  (%BC): 79.2] [Speech Therapy (%BC): 79.2] [All Other OP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74] [Observation (%BC): 74] [Emergency Department (%BC): 74] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 74] [Physical Therapy (%BC): 74] [Respiratory Services/Therapy  (%BC): 74] [Speech Therapy (%BC): 74] [All Other OP (%BC): 74]","count":"1 through 10","median_amount":1826.96,"10th_percentile":1826.96,"90th_percentile":1826.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 78] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"1 through 10","median_amount":208.57,"10th_percentile":208.57,"90th_percentile":208.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 39] [OP Surgery  (%BC): 39] [Observation (%BC): 39] [Emergency Department (%BC): 39] [Occupational Therapy (%BC): 39] [Physical Therapy (%BC): 39] [Respiratory Services/Therapy  (%BC): 39] [Speech Therapy (%BC): 39] [All Other OP (%BC): 39]","count":"1 through 10","median_amount":171.19,"10th_percentile":171.19,"90th_percentile":523.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"1 through 10","median_amount":1690.23,"10th_percentile":1690.23,"90th_percentile":1693.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":204.6,"10th_percentile":204.6,"90th_percentile":204.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Mycare Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 75] [OP Surgery  (%BC): 75] [Observation (%BC): 75] [Emergency Department (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [All Other OP (%BC): 75]","count":"11","median_amount":780.0,"10th_percentile":99.91,"90th_percentile":1071.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72] [OP Surgery  (%BC): 72] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 72] [Physical Therapy (%BC): 72] [Respiratory Services/Therapy  (%BC): 72] [Speech Therapy (%BC): 72] [All Other OP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"1 through 10","median_amount":693.77,"10th_percentile":693.77,"90th_percentile":693.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [ED Level 1--99281 ($): 27.09] [ED Level 2--99282 ($): 41.69] [ED Level 3--99283 ($): 73.69] [ED Level 4--99284 ($): 123.51] [ED Level 5--99285 ($): 223.93] [Clinic Visit ($): 59.34] [OP High Cost Drugs (%BC): 40] [Other Outpatient Implant (%BC): 40]","count":"1 through 10","median_amount":145.05,"10th_percentile":145.05,"90th_percentile":264.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"1 through 10","median_amount":458.88,"10th_percentile":458.88,"90th_percentile":458.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mammography Services","code_information":[{"code":"N804","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 84] [OP Surgery  (%BC): 84] [Observation (%BC): 84] [Emergency Department (%BC): 84] [Occupational Therapy (%BC): 84] [Physical Therapy (%BC): 84] [Respiratory Services/Therapy  (%BC): 84] [Speech Therapy (%BC): 84] [All Other OP (%BC): 84]","count":"59","median_amount":351.97,"10th_percentile":334.8,"90th_percentile":351.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":153.39,"10th_percentile":107.07,"90th_percentile":153.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41.82] [OP Surgery  (%BC): 41.82] [Observation (%BC): 41.82] [Emergency Department (%BC): 41.82] [Occupational Therapy (%BC): 41.82] [Physical Therapy (%BC): 41.82] [Respiratory Services/Therapy  (%BC): 41.82] [Speech Therapy (%BC): 41.82] [All Other OP (%BC): 41.82]","count":"186","median_amount":159.66,"10th_percentile":151.87,"90th_percentile":168.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [All OP services (%BC): 77.4] [OP Surgery  (%BC): 77.4] [Observation (%BC): 77.4] [Emergency Department (%BC): 77.4] [Occupational Therapy (%BC): 77.4] [Physical Therapy (%BC): 77.4] [Respiratory Services/Therapy  (%BC): 77.4] [Speech Therapy (%BC): 77.4] [All Other OP (%BC): 77.4]","count":"461","median_amount":333.78,"10th_percentile":278.6,"90th_percentile":333.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"11","median_amount":153.39,"10th_percentile":145.91,"90th_percentile":153.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41] [OP Surgery  (%BC): 41] [Observation (%BC): 41] [Emergency Department (%BC): 41] [Occupational Therapy (%BC): 41] [Physical Therapy (%BC): 41] [Respiratory Services/Therapy  (%BC): 41] [Speech Therapy (%BC): 41] [All Other OP (%BC): 41]","count":"102","median_amount":153.39,"10th_percentile":145.91,"90th_percentile":153.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 60.6] [OP Surgery  (%BC): 60.6] [Observation (%BC): 60.6] [Emergency Department (%BC): 60.6] [Occupational Therapy (%BC): 60.6] [Physical Therapy (%BC): 60.6] [Respiratory Services/Therapy  (%BC): 60.6] [Speech Therapy (%BC): 60.6] [All Other OP (%BC): 60.6]","count":"33","median_amount":261.44,"10th_percentile":251.91,"90th_percentile":261.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Bluecard Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"25","median_amount":156.52,"10th_percentile":148.89,"90th_percentile":156.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [Emergency Department ($): 40]","count":"44","median_amount":112.56,"10th_percentile":107.69,"90th_percentile":112.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":112.56,"10th_percentile":112.56,"90th_percentile":271.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 79.2] [OP Surgery  (%BC): 79.2] [Observation (%BC): 79.2] [Emergency Department (%BC): 79.2] [Occupational Therapy (%BC): 79.2] [Physical Therapy (%BC): 79.2] [Respiratory Services/Therapy  (%BC): 79.2] [Speech Therapy (%BC): 79.2] [All Other OP (%BC): 79.2]","count":"1 through 10","median_amount":335.05,"10th_percentile":318.7,"90th_percentile":335.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":338.44,"10th_percentile":338.44,"90th_percentile":338.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74] [Observation (%BC): 74] [Emergency Department (%BC): 74] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 74] [Physical Therapy (%BC): 74] [Respiratory Services/Therapy  (%BC): 74] [Speech Therapy (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 78] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"1 through 10","median_amount":118.19,"10th_percentile":113.08,"90th_percentile":118.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 39] [OP Surgery  (%BC): 39] [Observation (%BC): 39] [Emergency Department (%BC): 39] [Occupational Therapy (%BC): 39] [Physical Therapy (%BC): 39] [Respiratory Services/Therapy  (%BC): 39] [Speech Therapy (%BC): 39] [All Other OP (%BC): 39]","count":"51","median_amount":145.92,"10th_percentile":8.3,"90th_percentile":161.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"283","median_amount":138.01,"10th_percentile":112.52,"90th_percentile":158.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":113.77,"10th_percentile":113.77,"90th_percentile":113.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Mycare Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"1 through 10","median_amount":481.1,"10th_percentile":481.1,"90th_percentile":481.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 75] [OP Surgery  (%BC): 75] [Observation (%BC): 75] [Emergency Department (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [All Other OP (%BC): 75]","count":"152","median_amount":161.69,"10th_percentile":144.85,"90th_percentile":315.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72] [OP Surgery  (%BC): 72] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 72] [Physical Therapy (%BC): 72] [Respiratory Services/Therapy  (%BC): 72] [Speech Therapy (%BC): 72] [All Other OP (%BC): 72]","count":"1 through 10","median_amount":304.59,"10th_percentile":304.59,"90th_percentile":304.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"1 through 10","median_amount":342.04,"10th_percentile":342.04,"90th_percentile":342.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"54","median_amount":365.08,"10th_percentile":347.27,"90th_percentile":365.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"1 through 10","median_amount":364.83,"10th_percentile":347.04,"90th_percentile":364.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [ED Level 1--99281 ($): 27.09] [ED Level 2--99282 ($): 41.69] [ED Level 3--99283 ($): 73.69] [ED Level 4--99284 ($): 123.51] [ED Level 5--99285 ($): 223.93] [Clinic Visit ($): 59.34] [OP High Cost Drugs (%BC): 40] [Other Outpatient Implant (%BC): 40]","count":"1 through 10","median_amount":112.56,"10th_percentile":112.56,"90th_percentile":112.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"47","median_amount":100.69,"10th_percentile":100.69,"90th_percentile":372.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"1 through 10","median_amount":161.69,"10th_percentile":161.69,"90th_percentile":161.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":153.39,"10th_percentile":144.85,"90th_percentile":153.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Other Medicine","code_information":[{"code":"N809","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 84] [OP Surgery  (%BC): 84] [Observation (%BC): 84] [Emergency Department (%BC): 84] [Occupational Therapy (%BC): 84] [Physical Therapy (%BC): 84] [Respiratory Services/Therapy  (%BC): 84] [Speech Therapy (%BC): 84] [All Other OP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41.82] [OP Surgery  (%BC): 41.82] [Observation (%BC): 41.82] [Emergency Department (%BC): 41.82] [Occupational Therapy (%BC): 41.82] [Physical Therapy (%BC): 41.82] [Respiratory Services/Therapy  (%BC): 41.82] [Speech Therapy (%BC): 41.82] [All Other OP (%BC): 41.82]","count":"1 through 10","median_amount":150.79,"10th_percentile":150.79,"90th_percentile":150.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [All OP services (%BC): 77.4] [OP Surgery  (%BC): 77.4] [Observation (%BC): 77.4] [Emergency Department (%BC): 77.4] [Occupational Therapy (%BC): 77.4] [Physical Therapy (%BC): 77.4] [Respiratory Services/Therapy  (%BC): 77.4] [Speech Therapy (%BC): 77.4] [All Other OP (%BC): 77.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41] [OP Surgery  (%BC): 41] [Observation (%BC): 41] [Emergency Department (%BC): 41] [Occupational Therapy (%BC): 41] [Physical Therapy (%BC): 41] [Respiratory Services/Therapy  (%BC): 41] [Speech Therapy (%BC): 41] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 60.6] [OP Surgery  (%BC): 60.6] [Observation (%BC): 60.6] [Emergency Department (%BC): 60.6] [Occupational Therapy (%BC): 60.6] [Physical Therapy (%BC): 60.6] [Respiratory Services/Therapy  (%BC): 60.6] [Speech Therapy (%BC): 60.6] [All Other OP (%BC): 60.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Bluecard Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [Emergency Department ($): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 79.2] [OP Surgery  (%BC): 79.2] [Observation (%BC): 79.2] [Emergency Department (%BC): 79.2] [Occupational Therapy (%BC): 79.2] [Physical Therapy (%BC): 79.2] [Respiratory Services/Therapy  (%BC): 79.2] [Speech Therapy (%BC): 79.2] [All Other OP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74] [Observation (%BC): 74] [Emergency Department (%BC): 74] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 74] [Physical Therapy (%BC): 74] [Respiratory Services/Therapy  (%BC): 74] [Speech Therapy (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 78] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 39] [OP Surgery  (%BC): 39] [Observation (%BC): 39] [Emergency Department (%BC): 39] [Occupational Therapy (%BC): 39] [Physical Therapy (%BC): 39] [Respiratory Services/Therapy  (%BC): 39] [Speech Therapy (%BC): 39] [All Other OP (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"1 through 10","median_amount":1028.6,"10th_percentile":1028.6,"90th_percentile":1028.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Mycare Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 75] [OP Surgery  (%BC): 75] [Observation (%BC): 75] [Emergency Department (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [All Other OP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72] [OP Surgery  (%BC): 72] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 72] [Physical Therapy (%BC): 72] [Respiratory Services/Therapy  (%BC): 72] [Speech Therapy (%BC): 72] [All Other OP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [ED Level 1--99281 ($): 27.09] [ED Level 2--99282 ($): 41.69] [ED Level 3--99283 ($): 73.69] [ED Level 4--99284 ($): 123.51] [ED Level 5--99285 ($): 223.93] [Clinic Visit ($): 59.34] [OP High Cost Drugs (%BC): 40] [Other Outpatient Implant (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-covered Services","code_information":[{"code":"N900","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 84] [OP Surgery  (%BC): 84] [Observation (%BC): 84] [Emergency Department (%BC): 84] [Occupational Therapy (%BC): 84] [Physical Therapy (%BC): 84] [Respiratory Services/Therapy  (%BC): 84] [Speech Therapy (%BC): 84] [All Other OP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41.82] [OP Surgery  (%BC): 41.82] [Observation (%BC): 41.82] [Emergency Department (%BC): 41.82] [Occupational Therapy (%BC): 41.82] [Physical Therapy (%BC): 41.82] [Respiratory Services/Therapy  (%BC): 41.82] [Speech Therapy (%BC): 41.82] [All Other OP (%BC): 41.82]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [All OP services (%BC): 77.4] [OP Surgery  (%BC): 77.4] [Observation (%BC): 77.4] [Emergency Department (%BC): 77.4] [Occupational Therapy (%BC): 77.4] [Physical Therapy (%BC): 77.4] [Respiratory Services/Therapy  (%BC): 77.4] [Speech Therapy (%BC): 77.4] [All Other OP (%BC): 77.4]","count":"126","median_amount":558.89,"10th_percentile":386.08,"90th_percentile":896.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41] [OP Surgery  (%BC): 41] [Observation (%BC): 41] [Emergency Department (%BC): 41] [Occupational Therapy (%BC): 41] [Physical Therapy (%BC): 41] [Respiratory Services/Therapy  (%BC): 41] [Speech Therapy (%BC): 41] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 60.6] [OP Surgery  (%BC): 60.6] [Observation (%BC): 60.6] [Emergency Department (%BC): 60.6] [Occupational Therapy (%BC): 60.6] [Physical Therapy (%BC): 60.6] [Respiratory Services/Therapy  (%BC): 60.6] [Speech Therapy (%BC): 60.6] [All Other OP (%BC): 60.6]","count":"1 through 10","median_amount":436.94,"10th_percentile":315.89,"90th_percentile":746.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Bluecard Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [Emergency Department ($): 40]","count":"17","median_amount":0.88,"10th_percentile":0.88,"90th_percentile":0.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":1237.77,"10th_percentile":1237.77,"90th_percentile":1237.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 79.2] [OP Surgery  (%BC): 79.2] [Observation (%BC): 79.2] [Emergency Department (%BC): 79.2] [Occupational Therapy (%BC): 79.2] [Physical Therapy (%BC): 79.2] [Respiratory Services/Therapy  (%BC): 79.2] [Speech Therapy (%BC): 79.2] [All Other OP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74] [Observation (%BC): 74] [Emergency Department (%BC): 74] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 74] [Physical Therapy (%BC): 74] [Respiratory Services/Therapy  (%BC): 74] [Speech Therapy (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 78] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"1 through 10","median_amount":0.88,"10th_percentile":0.88,"90th_percentile":1299.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 39] [OP Surgery  (%BC): 39] [Observation (%BC): 39] [Emergency Department (%BC): 39] [Occupational Therapy (%BC): 39] [Physical Therapy (%BC): 39] [Respiratory Services/Therapy  (%BC): 39] [Speech Therapy (%BC): 39] [All Other OP (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":0.88,"10th_percentile":0.88,"90th_percentile":0.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Mycare Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 75] [OP Surgery  (%BC): 75] [Observation (%BC): 75] [Emergency Department (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [All Other OP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72] [OP Surgery  (%BC): 72] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 72] [Physical Therapy (%BC): 72] [Respiratory Services/Therapy  (%BC): 72] [Speech Therapy (%BC): 72] [All Other OP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [ED Level 1--99281 ($): 27.09] [ED Level 2--99282 ($): 41.69] [ED Level 3--99283 ($): 73.69] [ED Level 4--99284 ($): 123.51] [ED Level 5--99285 ($): 223.93] [Clinic Visit ($): 59.34] [OP High Cost Drugs (%BC): 40] [Other Outpatient Implant (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Packaged Services","code_information":[{"code":"N902","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 84] [OP Surgery  (%BC): 84] [Observation (%BC): 84] [Emergency Department (%BC): 84] [Occupational Therapy (%BC): 84] [Physical Therapy (%BC): 84] [Respiratory Services/Therapy  (%BC): 84] [Speech Therapy (%BC): 84] [All Other OP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41.82] [OP Surgery  (%BC): 41.82] [Observation (%BC): 41.82] [Emergency Department (%BC): 41.82] [Occupational Therapy (%BC): 41.82] [Physical Therapy (%BC): 41.82] [Respiratory Services/Therapy  (%BC): 41.82] [Speech Therapy (%BC): 41.82] [All Other OP (%BC): 41.82]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [All OP services (%BC): 77.4] [OP Surgery  (%BC): 77.4] [Observation (%BC): 77.4] [Emergency Department (%BC): 77.4] [Occupational Therapy (%BC): 77.4] [Physical Therapy (%BC): 77.4] [Respiratory Services/Therapy  (%BC): 77.4] [Speech Therapy (%BC): 77.4] [All Other OP (%BC): 77.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41] [OP Surgery  (%BC): 41] [Observation (%BC): 41] [Emergency Department (%BC): 41] [Occupational Therapy (%BC): 41] [Physical Therapy (%BC): 41] [Respiratory Services/Therapy  (%BC): 41] [Speech Therapy (%BC): 41] [All Other OP (%BC): 41]","count":"1 through 10","median_amount":388.12,"10th_percentile":388.12,"90th_percentile":388.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 60.6] [OP Surgery  (%BC): 60.6] [Observation (%BC): 60.6] [Emergency Department (%BC): 60.6] [Occupational Therapy (%BC): 60.6] [Physical Therapy (%BC): 60.6] [Respiratory Services/Therapy  (%BC): 60.6] [Speech Therapy (%BC): 60.6] [All Other OP (%BC): 60.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Bluecard Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [Emergency Department ($): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 79.2] [OP Surgery  (%BC): 79.2] [Observation (%BC): 79.2] [Emergency Department (%BC): 79.2] [Occupational Therapy (%BC): 79.2] [Physical Therapy (%BC): 79.2] [Respiratory Services/Therapy  (%BC): 79.2] [Speech Therapy (%BC): 79.2] [All Other OP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74] [Observation (%BC): 74] [Emergency Department (%BC): 74] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 74] [Physical Therapy (%BC): 74] [Respiratory Services/Therapy  (%BC): 74] [Speech Therapy (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 78] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"1 through 10","median_amount":27.21,"10th_percentile":27.21,"90th_percentile":27.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 39] [OP Surgery  (%BC): 39] [Observation (%BC): 39] [Emergency Department (%BC): 39] [Occupational Therapy (%BC): 39] [Physical Therapy (%BC): 39] [Respiratory Services/Therapy  (%BC): 39] [Speech Therapy (%BC): 39] [All Other OP (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Mycare Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 75] [OP Surgery  (%BC): 75] [Observation (%BC): 75] [Emergency Department (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [All Other OP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72] [OP Surgery  (%BC): 72] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 72] [Physical Therapy (%BC): 72] [Respiratory Services/Therapy  (%BC): 72] [Speech Therapy (%BC): 72] [All Other OP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"1 through 10","median_amount":1147.22,"10th_percentile":1147.22,"90th_percentile":1147.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [ED Level 1--99281 ($): 27.09] [ED Level 2--99282 ($): 41.69] [ED Level 3--99283 ($): 73.69] [ED Level 4--99284 ($): 123.51] [ED Level 5--99285 ($): 223.93] [Clinic Visit ($): 59.34] [OP High Cost Drugs (%BC): 40] [Other Outpatient Implant (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Not Recognized by OPPS","code_information":[{"code":"N905","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 84] [OP Surgery  (%BC): 84] [Observation (%BC): 84] [Emergency Department (%BC): 84] [Occupational Therapy (%BC): 84] [Physical Therapy (%BC): 84] [Respiratory Services/Therapy  (%BC): 84] [Speech Therapy (%BC): 84] [All Other OP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41.82] [OP Surgery  (%BC): 41.82] [Observation (%BC): 41.82] [Emergency Department (%BC): 41.82] [Occupational Therapy (%BC): 41.82] [Physical Therapy (%BC): 41.82] [Respiratory Services/Therapy  (%BC): 41.82] [Speech Therapy (%BC): 41.82] [All Other OP (%BC): 41.82]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [All OP services (%BC): 77.4] [OP Surgery  (%BC): 77.4] [Observation (%BC): 77.4] [Emergency Department (%BC): 77.4] [Occupational Therapy (%BC): 77.4] [Physical Therapy (%BC): 77.4] [Respiratory Services/Therapy  (%BC): 77.4] [Speech Therapy (%BC): 77.4] [All Other OP (%BC): 77.4]","count":"1 through 10","median_amount":2011.62,"10th_percentile":2011.62,"90th_percentile":2011.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41] [OP Surgery  (%BC): 41] [Observation (%BC): 41] [Emergency Department (%BC): 41] [Occupational Therapy (%BC): 41] [Physical Therapy (%BC): 41] [Respiratory Services/Therapy  (%BC): 41] [Speech Therapy (%BC): 41] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 60.6] [OP Surgery  (%BC): 60.6] [Observation (%BC): 60.6] [Emergency Department (%BC): 60.6] [Occupational Therapy (%BC): 60.6] [Physical Therapy (%BC): 60.6] [Respiratory Services/Therapy  (%BC): 60.6] [Speech Therapy (%BC): 60.6] [All Other OP (%BC): 60.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Bluecard Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [Emergency Department ($): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 79.2] [OP Surgery  (%BC): 79.2] [Observation (%BC): 79.2] [Emergency Department (%BC): 79.2] [Occupational Therapy (%BC): 79.2] [Physical Therapy (%BC): 79.2] [Respiratory Services/Therapy  (%BC): 79.2] [Speech Therapy (%BC): 79.2] [All Other OP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74] [Observation (%BC): 74] [Emergency Department (%BC): 74] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 74] [Physical Therapy (%BC): 74] [Respiratory Services/Therapy  (%BC): 74] [Speech Therapy (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 78] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 39] [OP Surgery  (%BC): 39] [Observation (%BC): 39] [Emergency Department (%BC): 39] [Occupational Therapy (%BC): 39] [Physical Therapy (%BC): 39] [Respiratory Services/Therapy  (%BC): 39] [Speech Therapy (%BC): 39] [All Other OP (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"1 through 10","median_amount":1873.94,"10th_percentile":1873.94,"90th_percentile":1873.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Mycare Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 75] [OP Surgery  (%BC): 75] [Observation (%BC): 75] [Emergency Department (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [All Other OP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72] [OP Surgery  (%BC): 72] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 72] [Physical Therapy (%BC): 72] [Respiratory Services/Therapy  (%BC): 72] [Speech Therapy (%BC): 72] [All Other OP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [ED Level 1--99281 ($): 27.09] [ED Level 2--99282 ($): 41.69] [ED Level 3--99283 ($): 73.69] [ED Level 4--99284 ($): 123.51] [ED Level 5--99285 ($): 223.93] [Clinic Visit ($): 59.34] [OP High Cost Drugs (%BC): 40] [Other Outpatient Implant (%BC): 40]","count":"1 through 10","median_amount":193.34,"10th_percentile":193.34,"90th_percentile":193.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Partial Hospitalization","code_information":[{"code":"N908","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 84] [OP Surgery  (%BC): 84] [Observation (%BC): 84] [Emergency Department (%BC): 84] [Occupational Therapy (%BC): 84] [Physical Therapy (%BC): 84] [Respiratory Services/Therapy  (%BC): 84] [Speech Therapy (%BC): 84] [All Other OP (%BC): 84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Mycare Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41.82] [OP Surgery  (%BC): 41.82] [Observation (%BC): 41.82] [Emergency Department (%BC): 41.82] [Occupational Therapy (%BC): 41.82] [Physical Therapy (%BC): 41.82] [Respiratory Services/Therapy  (%BC): 41.82] [Speech Therapy (%BC): 41.82] [All Other OP (%BC): 41.82]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [All OP services (%BC): 77.4] [OP Surgery  (%BC): 77.4] [Observation (%BC): 77.4] [Emergency Department (%BC): 77.4] [Occupational Therapy (%BC): 77.4] [Physical Therapy (%BC): 77.4] [Respiratory Services/Therapy  (%BC): 77.4] [Speech Therapy (%BC): 77.4] [All Other OP (%BC): 77.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 41] [OP Surgery  (%BC): 41] [Observation (%BC): 41] [Emergency Department (%BC): 41] [Occupational Therapy (%BC): 41] [Physical Therapy (%BC): 41] [Respiratory Services/Therapy  (%BC): 41] [Speech Therapy (%BC): 41] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Pathway Exchange","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 60.6] [OP Surgery  (%BC): 60.6] [Observation (%BC): 60.6] [Emergency Department (%BC): 60.6] [Occupational Therapy (%BC): 60.6] [Physical Therapy (%BC): 60.6] [Respiratory Services/Therapy  (%BC): 60.6] [Speech Therapy (%BC): 60.6] [All Other OP (%BC): 60.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Bluecard Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [Emergency Department ($): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 79.2] [OP Surgery  (%BC): 79.2] [Observation (%BC): 79.2] [Emergency Department (%BC): 79.2] [Occupational Therapy (%BC): 79.2] [Physical Therapy (%BC): 79.2] [Respiratory Services/Therapy  (%BC): 79.2] [Speech Therapy (%BC): 79.2] [All Other OP (%BC): 79.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Custom Design Benefits 20/20","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 80] [OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Frontpath","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74] [Observation (%BC): 74] [Emergency Department (%BC): 74] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 74] [Physical Therapy (%BC): 74] [Respiratory Services/Therapy  (%BC): 74] [Speech Therapy (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Gerken Employer Group","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 78] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 39] [OP Surgery  (%BC): 39] [Observation (%BC): 39] [Emergency Department (%BC): 39] [Occupational Therapy (%BC): 39] [Physical Therapy (%BC): 39] [Respiratory Services/Therapy  (%BC): 39] [Speech Therapy (%BC): 39] [All Other OP (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual Of Ohio","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 76] [OP Surgery  (%BC): 76] [Observation (%BC): 76] [Emergency Department (%BC): 76] [Occupational Therapy (%BC): 76] [Physical Therapy (%BC): 76] [Respiratory Services/Therapy  (%BC): 76] [Speech Therapy (%BC): 76] [All Other OP (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Mycare Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 85] [OP Surgery  (%BC): 85] [Observation (%BC): 85] [Emergency Department (%BC): 85] [Occupational Therapy (%BC): 85] [Physical Therapy (%BC): 85] [Respiratory Services/Therapy  (%BC): 85] [Speech Therapy (%BC): 85] [All Other OP (%BC): 85]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 75] [OP Surgery  (%BC): 75] [Observation (%BC): 75] [Emergency Department (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [All Other OP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Parkview Signature Care","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 72] [OP Surgery  (%BC): 72] [Observation (%BC): 72] [Emergency Department (%BC): 72] [Occupational Therapy (%BC): 72] [Physical Therapy (%BC): 72] [Respiratory Services/Therapy  (%BC): 72] [Speech Therapy (%BC): 72] [All Other OP (%BC): 72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 88] [OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"1 through 10","median_amount":94.66,"10th_percentile":94.66,"90th_percentile":94.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy] [ED Level 1--99281 ($): 27.09] [ED Level 2--99282 ($): 41.69] [ED Level 3--99283 ($): 73.69] [ED Level 4--99284 ($): 123.51] [ED Level 5--99285 ($): 223.93] [Clinic Visit ($): 59.34] [OP High Cost Drugs (%BC): 40] [Other Outpatient Implant (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[All OP services (%BC): 89] [OP Surgery  (%BC): 89] [Observation (%BC): 89] [Emergency Department (%BC): 89] [Occupational Therapy (%BC): 89] [Physical Therapy (%BC): 89] [Respiratory Services/Therapy  (%BC): 89] [Speech Therapy (%BC): 89] [All Other OP (%BC): 89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare and Medicaid payment methodology. Medicare logic based on reasonable costs. Available, referenceable Medicaid algorithm logic found here: https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]}]}